Healthcare Provider Details

I. General information

NPI: 1689084998
Provider Name (Legal Business Name): MATTHEW BURNS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W HILL BLVD
JOINT BASE CHARLESTON SC
29404-4704
US

IV. Provider business mailing address

204 W HILL BLVD
CHARLESTON AFB SC
29404-4704
US

V. Phone/Fax

Practice location:
  • Phone: 843-963-6864
  • Fax:
Mailing address:
  • Phone: 781-910-6074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number635444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: