Healthcare Provider Details

I. General information

NPI: 1700125945
Provider Name (Legal Business Name): MUNIRAH BADER BURASHED DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 12TH AVE
COLUMBUS OH
43210-1267
US

IV. Provider business mailing address

97 OLENTANGY PT
COLUMBUS OH
43202-1984
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-4927
  • Fax:
Mailing address:
  • Phone: 614-316-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3095
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: