Healthcare Provider Details

I. General information

NPI: 1912999194
Provider Name (Legal Business Name): ROBERT D. BURNARD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4998 W BROAD ST SUITE 102
COLUMBUS OH
43228-1647
US

IV. Provider business mailing address

4998 W BROAD ST SUITE 102
COLUMBUS OH
43228-1647
US

V. Phone/Fax

Practice location:
  • Phone: 614-878-8249
  • Fax:
Mailing address:
  • Phone: 614-878-8249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13852
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: