=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811588221
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANIEL J. BURGIN, D.M.D. PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2021
-----------------------------------------------------
Last Update Date | 01/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6230 HIGHLAND PLACE WAY STE 102
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37919-4037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-584-5611
-----------------------------------------------------
Fax | 865-588-8170
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6230 HIGHLAND PLACE WAY STE 102
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37919-4037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-584-5611
-----------------------------------------------------
Fax | 865-588-8170
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DANIEL JOHN BURGIN
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 865-584-5611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------