Healthcare Provider Details

I. General information

NPI: 1396883211
Provider Name (Legal Business Name): MICHAEL J. BURNES, DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 HARVARD ST SUITE #300
BROOKLINE MA
02446-5071
US

IV. Provider business mailing address

209 HARVARD ST SUITE #300
BROOKLINE MA
02446-5071
US

V. Phone/Fax

Practice location:
  • Phone: 617-277-3127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14810
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12349
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number16594
License Number StateMA

VIII. Authorized Official

Name: DR. MICHAEL BURNES
Title or Position: OWNER
Credential: DMD
Phone: 617-277-3127