Healthcare Provider Details

I. General information

NPI: 1275465346
Provider Name (Legal Business Name): ANGELA BURKE DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1471 CHESTER BLVD STE B
RICHMOND IN
47374-1946
US

IV. Provider business mailing address

1471 CHESTER BLVD STE B
RICHMOND IN
47374-1946
US

V. Phone/Fax

Practice location:
  • Phone: 765-962-4774
  • Fax: 765-939-1531
Mailing address:
  • Phone: 765-962-4774
  • Fax: 765-939-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ANGELA G BURKE
Title or Position: DOCTOR/DENTIST
Credential: DDS
Phone: 765-962-4774