Healthcare Provider Details

I. General information

NPI: 1679654636
Provider Name (Legal Business Name): DAVID T BURNELL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KAREN D BURNELL PRACTICE ADMIN.

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7785 M-36
HAMBURG MI
48139-0569
US

IV. Provider business mailing address

PO BOX 569
HAMBURG MI
48139-0569
US

V. Phone/Fax

Practice location:
  • Phone: 810-231-9630
  • Fax: 810-231-6329
Mailing address:
  • Phone: 810-231-9630
  • Fax: 810-231-6329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number013426
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: