Healthcare Provider Details

I. General information

NPI: 1770686156
Provider Name (Legal Business Name): LISA R BURKETT DDS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6818 AUSTIN CENTER BLVD STE 203
AUSTIN TX
78731
US

IV. Provider business mailing address

6818 AUSTIN CENTER BLVD STE 203
AUSTIN TX
78731
US

V. Phone/Fax

Practice location:
  • Phone: 512-458-1162
  • Fax: 512-458-1747
Mailing address:
  • Phone: 512-458-1162
  • Fax: 512-458-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number17061
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: