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General NPI Number Information
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NPI Number | 1760684930
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Entity Type | Individual
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Provider Name | JEFFREY JOSEPH BURKE D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2323 S 109TH ST STE 275
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City | WEST ALLIS
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State | WI
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Zip | 53227-1912
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Country | US
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Telephone | 414-321-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 3660 N LAKE SHORE DR APT 3509
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City | CHICAGO
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State | IL
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Zip | 60613-5315
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Country | US
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Telephone | 617-851-6097
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 6104-015
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License Number State | WI
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