=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881792414
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN MARIE BURKE D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 02/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18440 N 7TH ST SUITE 10
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85022-1125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-866-2102
-----------------------------------------------------
Fax | 602-866-0046
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4145 N 49TH ST
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85018-4454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-369-1035
-----------------------------------------------------
Fax | 602-595-9348
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 30.021887
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | D5885
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------