Healthcare Provider Details

I. General information

NPI: 1033788153
Provider Name (Legal Business Name): KATHERINE BURKETT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 PLAZA DR STE J
COLUMBUS IN
47201-2940
US

IV. Provider business mailing address

4526 WOODLAND DR
INDIANAPOLIS IN
46254-2093
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-9335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12013642A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: