Healthcare Provider Details

I. General information

NPI: 1033123617
Provider Name (Legal Business Name): JEFF S BURG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

678 E VINE ST 12
MURRAY UT
84107
US

IV. Provider business mailing address

9161 S WEDGEFIELD DR
SANDY UT
84093
US

V. Phone/Fax

Practice location:
  • Phone: 801-268-1135
  • Fax: 801-685-7630
Mailing address:
  • Phone: 801-268-1135
  • Fax: 801-685-7630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5096414
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: