Healthcare Provider Details

I. General information

NPI: 1154317501
Provider Name (Legal Business Name): GERMAN BURKE ORTHODONTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 NORTH MAIN STREET
CENTERVILLE OH
45459-4658
US

IV. Provider business mailing address

55 N MAIN ST
CENTERVILLE OH
45459-4658
US

V. Phone/Fax

Practice location:
  • Phone: 937-435-2374
  • Fax: 937-434-5959
Mailing address:
  • Phone: 937-435-2374
  • Fax: 937-434-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. DANIEL S GERMAN
Title or Position: CHAIRMAN
Credential: DDS
Phone: 937-435-2374