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General NPI Number Information
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NPI Number | 1124248836
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Entity Type | Organization
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Legal Business Name | WESLEY J BURKE DDS AND CYNTHIA P HALL DMD
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 160 SAILORS DR
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City | ELLIJAY
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State | GA
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Zip | 30540-3743
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Country | US
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Telephone | 706-276-2828
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Fax | 706-276-2826
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Provider Business Mailing Address
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Address Line | PO BOX 565 160 SAILORS DRIVE
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City | ELLIJAY
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State | GA
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Zip | 30540-0008
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Country | US
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Telephone | 706-276-2828
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Fax | 706-276-2826
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CATHERINE B BURKE
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Credential |
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Telephone | 706-276-2828
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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 | 011546
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7996
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License Number State | GA
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