Healthcare Provider Details

I. General information

NPI: 1447815931
Provider Name (Legal Business Name): DR. SHAWN BURL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 3RD AVE W
BIRMINGHAM AL
35204-4114
US

IV. Provider business mailing address

139 3RD AVE W
BIRMINGHAM AL
35204-4114
US

V. Phone/Fax

Practice location:
  • Phone: 205-254-8555
  • Fax:
Mailing address:
  • Phone: 205-254-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAWN BURL
Title or Position: OWNER
Credential: DDS
Phone: 205-254-8555