MEDICARE: DR. EDWARD BURG D.M.D

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	DI020794	NJ

General Provider Information

NPI Number	:	1417129537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD BURG D.M.D

Provider Business Mailing Address
First Line	:	853 MILL CREEK RD
Second Line	:	SUITE # 7 & 8
City	:	MANAHAWKIN
State	:	NJ
Zip	:	08050-4562
Country	:	US
Telephone Number	:	609-978-7440
Fax Number	:	609-978-5498

Provider Business Practice Location Address
First Line	:	853 MILL CREEK RD
Second Line	:	SUITE # 7 & 8
City	:	MANAHAWKIN
State	:	NJ
Zip	:	08050-4562
Country	:	US
Telephone Number	:	609-978-7440
Fax Number	:	609-978-5498

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

Provider Enumeration Date	:	03/28/2008
Last Update Date	:	03/28/2008

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