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General NPI Number Information
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NPI Number | 1033431085
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Entity Type | Organization
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Legal Business Name | E BURKE JARDINE, DMD, PC
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 2680 S VAL VISTA DR STE 125
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City | GILBERT
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State | AZ
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Zip | 85295-2154
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Country | US
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Telephone | 480-553-9909
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Fax | 480-553-9905
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Provider Business Mailing Address
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Address Line | 2680 S VAL VISTA DR STE 125
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City | GILBERT
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State | AZ
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Zip | 85295-2154
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Country | US
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Telephone | 480-553-9909
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Fax | 480-553-9905
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Authorized Official
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Title or Position | FRONT OFFICE MANAGER
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Name | TARA EAGAR
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Credential |
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Telephone | 480-553-9909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D7758
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D7240
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License Number State | AZ
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