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General NPI Number Information
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NPI Number | 1740447465
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Entity Type | Organization
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Legal Business Name | EDWARD G. BURNETT JR. D.D.S.,P.A.
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 1900 S HAWTHORNE RD STE 552
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City | WINSTON SALEM
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State | NC
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Zip | 27103-3913
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Country | US
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Telephone | 336-760-4304
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Fax | 336-765-0124
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Provider Business Mailing Address
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Address Line | 1900 S HAWTHORNE RD STE 552
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City | WINSTON SALEM
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State | NC
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Zip | 27103-3913
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Country | US
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Telephone | 336-760-4304
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Fax | 336-765-0124
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD GUEST BURNETT JR.
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Credential | DDS
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Telephone | 336-760-4304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 3900
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License Number State | NC
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