Healthcare Provider Details

I. General information

NPI: 1316669567
Provider Name (Legal Business Name): DMS OF BURLINGTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 PROFESSIONAL PARK DR
BURLINGTON NC
27215-9388
US

IV. Provider business mailing address

2960 PROFESSIONAL PARK DR
BURLINGTON NC
27215-9388
US

V. Phone/Fax

Practice location:
  • Phone: 336-228-8159
  • Fax:
Mailing address:
  • Phone: 336-228-8159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. EMILY LAINE DORNBLAZER
Title or Position: MANAGER
Credential: DMD
Phone: 336-228-8159