Healthcare Provider Details

I. General information

NPI: 1306800776
Provider Name (Legal Business Name): JAMES C BURNS DDS, MSED, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 12TH ST
RICHMOND VA
23219-1610
US

IV. Provider business mailing address

PO BOX 980566
RICHMOND VA
23298-0566
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-3630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number0401004205
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: