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General NPI Number Information
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NPI Number | 1639341480
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Entity Type | Organization
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Legal Business Name | JOHN P. BURKE, D.M.D.,P.C.
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 21 GEORGE ST 2ND FLOOR
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City | LOWELL
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State | MA
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Zip | 01852-2228
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Country | US
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Telephone | 978-454-0774
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Fax | 978-934-9993
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Provider Business Mailing Address
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Address Line | 21 GEORGE ST
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City | LOWELL
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State | MA
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Zip | 01852-2228
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Country | US
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Telephone | 978-454-0774
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Fax | 978-934-9993
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN P BURKE
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Credential | D.M.D.
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Telephone | 978-454-0774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 11854
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License Number State | MA
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