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General NPI Number Information
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NPI Number | 1043589088
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Entity Type | Individual
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Provider Name | GROVER PRESTON BURNS JR. DENTIST
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Gender | Male
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 242 BUTLER RD SUITE 101
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City | FREDERICKSBURG
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State | VA
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Zip | 22405-2441
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Country | US
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Telephone | 540-373-6557
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Fax | 540-373-6562
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Provider Business Mailing Address
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Address Line | 242 BUTLER RD SUITE 101
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City | FREDERICKSBURG
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State | VA
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Zip | 22405-2441
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Country | US
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Telephone | 540-373-6557
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Fax | 540-373-6562
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401004384
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License Number State | VA
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