MEDICARE: DR. BURL BERT BUSKIRK JR. DDS, MA, CDP

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	4323	WA
2	101Y00000X	Counselor	CP60058536	WA

General Provider Information

NPI Number	:	1407872237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BURL BERT BUSKIRK JR. DDS, MA, CDP

Provider Business Mailing Address
First Line	:	3214 50TH STREET COURT
Second Line	:	SUITE 305
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-8589
Country	:	US
Telephone Number	:	253-851-4600
Fax Number	:	253-851-4602

Provider Business Practice Location Address
First Line	:	3214 50TH STREET COURT
Second Line	:	SUITE 305
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-8589
Country	:	US
Telephone Number	:	253-851-4600
Fax Number	:	253-851-4602

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	08/19/2009

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