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General NPI Number Information
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NPI Number | 1659477727
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Entity Type | Individual
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Provider Name | MARK C BURNE D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 05/04/2009
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Provider Practice Location Address
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Address Line | 2787 SYCAMORE ST BUILDING F, SUITE 106
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City | NORTH PORT
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State | FL
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Zip | 34289
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Country | US
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Telephone | 941-423-1750
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Fax |
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Provider Business Mailing Address
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Address Line | 2787 SYCAMORE ST BUILDING F, SUITE 106
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City | NORTH PORT
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State | FL
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Zip | 34289
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Country | US
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Telephone |
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Fax |
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN18166
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License Number State | FL
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