Healthcare Provider Details

I. General information

NPI: 1114302395
Provider Name (Legal Business Name): PATRICK BURKARDT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 HEISS RD
MONROE MI
48162-9406
US

IV. Provider business mailing address

2015 HEISS RD
MONROE MI
48162-9406
US

V. Phone/Fax

Practice location:
  • Phone: 734-621-2532
  • Fax:
Mailing address:
  • Phone: 734-621-2532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901021686
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: