MEDICARE: CRAIG N BURHOOP DDS PC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1184191678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAIG N BURHOOP DDS PC

Provider Business Mailing Address
First Line	:	3434 S LAKEPORT ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-4509
Country	:	US
Telephone Number	:	712-276-8391
Fax Number	:	712-276-8403

Provider Business Practice Location Address
First Line	:	3434 S LAKEPORT ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-4509
Country	:	US
Telephone Number	:	712-276-8391
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BRENDA MILLER
Credential	:
Telephone Number	:	712-276-8391

Provider Enumeration Date	:	11/01/2018
Last Update Date	:	11/01/2018

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