Healthcare Provider Details

I. General information

NPI: 1558121780
Provider Name (Legal Business Name): ALBERT BURROW D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 S MINT ST STE A
CHARLOTTE NC
28203-4360
US

IV. Provider business mailing address

2701 SHARON RD
CHARLOTTE NC
28211-1609
US

V. Phone/Fax

Practice location:
  • Phone: 704-334-7202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number13175
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number10939
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: