Healthcare Provider Details

I. General information

NPI: 1891468930
Provider Name (Legal Business Name): THOMAS. J. BURDO, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 4 MILE RD. NW
GRAND RAPIDS MI
49555-7397
US

IV. Provider business mailing address

1100 4 MILE RD. NW
GRAND RAPIDS MI
49555-7397
US

V. Phone/Fax

Practice location:
  • Phone: 616-784-6377
  • Fax: 616-784-8472
Mailing address:
  • Phone: 616-784-6377
  • Fax: 616-784-8472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS J BURDO
Title or Position: OWNER / DENTIST
Credential: DDS
Phone: 616-784-6377