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NPI Code Detail

MEDICARE: DR. SANDRA BURCH DMD

MEDICARE: DR. SANDRA BURCH DMD
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
1122300000XDentist2462-89MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801837265
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SANDRA BURCH DMD
Provider Business Mailing Address
First Line : 3502 W NORTHSIDE DR
Second Line :
City : JACKSON
State : MS
Zip : 39213-4454
Country : US
Telephone Number : 601-362-5321
Fax Number :
Provider Business Practice Location Address
First Line : 3502 W NORTHSIDE DR
Second Line :
City : JACKSON
State : MS
Zip : 39213-4454
Country : US
Telephone Number : 601-362-5321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2006
Last Update Date : 05/02/2016

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Directions to “ DR. SANDRA BURCH DMD” Practice Location

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