MEDICARE: DENTISTRY AT THE COMMONS

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	:	1194365643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTISTRY AT THE COMMONS

Provider Business Mailing Address
First Line	:	77 ANGUS RUN
Second Line	:
City	:	SENECA
State	:	SC
Zip	:	29672-6657
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 PROFESSIONALS CIR
Second Line	:
City	:	SENECA
State	:	SC
Zip	:	29678-2669
Country	:	US
Telephone Number	:	864-882-0134
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LINDSEY D BURBANK JR.
Credential	:	DDS
Telephone Number	:	352-250-7079

Provider Enumeration Date	:	01/13/2020
Last Update Date	:	01/13/2020

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Directions to “DENTISTRY AT THE COMMONS ” Practice Location

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