Healthcare Provider Details

I. General information

NPI: 1487545752
Provider Name (Legal Business Name): KATHRYN ANNE BURCHFIELD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOSPITAL DR UNIT A
CRESTVIEW FL
32539-7385
US

IV. Provider business mailing address

205 HAMMOCK TRL E APT K206
FREEPORT FL
32439-7699
US

V. Phone/Fax

Practice location:
  • Phone: 850-682-1164
  • Fax:
Mailing address:
  • Phone: 205-415-7335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30749
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: