Healthcare Provider Details

I. General information

NPI: 1699338202
Provider Name (Legal Business Name): SYDNEY COLLETTE BURCL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 03/10/2024
Certification Date: 03/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7551 FOREST OAKS BLVD
SPRING HILL FL
34606-2437
US

IV. Provider business mailing address

7551 FOREST OAKS BLVD
SPRING HILL FL
34606-2437
US

V. Phone/Fax

Practice location:
  • Phone: 352-518-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4045-19
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN27531
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11290
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: