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NPI Code Detail

MEDICARE: DR. MATTHEW DENT BURKS DDS, MD

MEDICARE:  DR. MATTHEW DENT BURKS  DDS, MD
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
1204E00000XOral & Maxillofacial Surgery (D.M.D.)R9727TX
21223S0112XOral and Maxillofacial Surgery (Dentist)28894TX

General Provider Information

NPI Number : 1427493055
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW DENT BURKS DDS, MD
Provider Business Mailing Address
First Line : 1701 MOORES LN
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-1894
Country : US
Telephone Number : 903-794-3331
Fax Number : 903-793-7217
Provider Business Practice Location Address
First Line : 1701 MOORES LN
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-1894
Country : US
Telephone Number : 903-794-3331
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2013
Last Update Date : 05/07/2020

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