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General NPI Number Information
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NPI Number | 1912176686
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Entity Type | Organization
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Legal Business Name | JONATHAN S. BURKE, DDS, PC
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 1410 E JOLIET ST SUITE D
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City | CROWN POINT
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State | IN
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Zip | 46307-4724
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Country | US
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Telephone | 219-662-9932
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Fax | 219-663-9688
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Provider Business Mailing Address
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Address Line | 1410 E JOLIET ST SUITE D
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City | CROWN POINT
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State | IN
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Zip | 46307-4724
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Country | US
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Telephone | 219-662-9932
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Fax | 219-663-9688
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONATHAN SCOTT BURKE
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Credential | DDS
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Telephone | 219-662-9932
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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 | 12009850
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License Number State | IN
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