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General NPI Number Information
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NPI Number | 1811333156
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Entity Type | Organization
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Legal Business Name | BURCH DENTAL
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 9721 N ALPINE RD
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City | MACHESNEY PARK
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State | IL
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Zip | 61115-1664
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Country | US
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Telephone | 815-633-9864
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Fax |
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Provider Business Mailing Address
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Address Line | 8100 FOREST HILLS RD
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City | LOVES PARK
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State | IL
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Zip | 61111-2709
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Country | US
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Telephone | 815-633-9864
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Fax |
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | MELISSA KAY MILLER
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Credential |
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Telephone | 815-631-2389
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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 | 19026526
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License Number State | IL
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