MEDICARE: DR. THOMAS C BURM JR. DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	0479561	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174638183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS C BURM JR. DMD

Provider Business Mailing Address
First Line	:	523 BEAHAN RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-3403
Country	:	US
Telephone Number	:	585-426-2550
Fax Number	:	585-426-4118

Provider Business Practice Location Address
First Line	:	523 BEAHAN RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-3403
Country	:	US
Telephone Number	:	585-426-2550
Fax Number	:	585-426-4118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	09/09/2014

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