Healthcare Provider Details

I. General information

NPI: 1518263938
Provider Name (Legal Business Name): THOMAS E BURKE JR DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 COOPERS LANDING RD
HEATHSVILLE VA
22473-3504
US

IV. Provider business mailing address

361 COOPERS LANDING RD
HEATHSVILLE VA
22473-3504
US

V. Phone/Fax

Practice location:
  • Phone: 804-580-3860
  • Fax: 804-580-6220
Mailing address:
  • Phone: 804-580-3860
  • Fax: 804-580-6220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401007451
License Number StateVA

VIII. Authorized Official

Name: DR. THOMAS E BURKE JR.
Title or Position: PRESIDENT
Credential: DDS
Phone: 804-580-3860