Healthcare Provider Details

I. General information

NPI: 1992778450
Provider Name (Legal Business Name): CARRIE LEE BURGER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1173 WHIPPLE RD
NEWPORT RI
02841
US

IV. Provider business mailing address

RTE 12, BLDG 449, ATTN: PROFESSIONAL AFFAIRS NAVAL HEALTH CARE NEW ENGLAND, GROTON
GROTON CT
06349-5600
US

V. Phone/Fax

Practice location:
  • Phone: 860-694-2377
  • Fax: 860-694-3590
Mailing address:
  • Phone: 860-694-2377
  • Fax: 860-694-2590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10337
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number10337
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: