MEDICARE: BURK SMILES PLLC

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	1223G0001X	General Practice Dentistry	31227	TX

General Provider Information

NPI Number	:	1376099739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURK SMILES PLLC

Provider Business Mailing Address
First Line	:	412B SOUTH AVE D
Second Line	:
City	:	BURKBURNETT
State	:	TX
Zip	:	76354-3542
Country	:	US
Telephone Number	:	817-992-7005
Fax Number	:

Provider Business Practice Location Address
First Line	:	412B SOUTH AVE D
Second Line	:
City	:	BURKBURNETT
State	:	TX
Zip	:	76354-3542
Country	:	US
Telephone Number	:	817-992-7005
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	NAVJOT KAUR RANDHAWA
Credential	:	DMD
Telephone Number	:	817-992-7005

Provider Enumeration Date	:	08/26/2016
Last Update Date	:	09/09/2016

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Directions to “BURK SMILES PLLC ” Practice Location

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