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General NPI Number Information
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NPI Number | 1235356122
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Entity Type | Individual
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Provider Name | CHARLES E. BURNHAM JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 900 S. GARNETT ST.
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City | HENDERSON
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State | NC
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Zip | 27536-0012
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Country | US
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Telephone | 252-438-3145
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Fax | 252-430-8228
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Provider Business Mailing Address
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Address Line | P.O. BOX 12
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City | HENDERSON
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State | NC
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Zip | 27536-0012
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Country | US
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Telephone | 252-438-3145
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Fax | 252-430-8228
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 4705
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License Number State | NC
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