Healthcare Provider Details

I. General information

NPI: 1578940730
Provider Name (Legal Business Name): CHARLES BURCHFIELD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 W HENRIETTA RD STE 5J
ROCHESTER NY
14623-1360
US

IV. Provider business mailing address

601 ELMWOOD AVE # 705
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-292-1270
  • Fax:
Mailing address:
  • Phone: 585-275-9004
  • Fax: 585-276-1883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number04490
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number061194
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: