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NPI Code Detail

MEDICARE: DR. NORMA UBALDE BURNLEY D.D.S., D.M.D.

MEDICARE: DR. NORMA UBALDE BURNLEY D.D.S., 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
11223G0001XGeneral Practice Dentistry1022NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11022OTHERNVDENTAL LICENSE

General Provider Information

NPI Number : 1457645780
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NORMA UBALDE BURNLEY D.D.S., D.M.D.
Provider Business Mailing Address
First Line : 5140 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-2305
Country : US
Telephone Number : 702-891-0079
Fax Number : 702-891-0455
Provider Business Practice Location Address
First Line : 5140 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-2305
Country : US
Telephone Number : 702-891-0079
Fax Number : 702-891-0455
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2011
Last Update Date : 06/03/2011

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