MEDICARE: DR. MARK C BURNE 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN18166	FL

General Provider Information

NPI Number	:	1659477727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK C BURNE D.M.D.

Provider Business Mailing Address
First Line	:	2787 SYCAMORE ST
Second Line	:	BUILDING F, SUITE 106
City	:	NORTH PORT
State	:	FL
Zip	:	34289
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2787 SYCAMORE ST
Second Line	:	BUILDING F, SUITE 106
City	:	NORTH PORT
State	:	FL
Zip	:	34289
Country	:	US
Telephone Number	:	941-423-1750
Fax Number	:

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	05/04/2009

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