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NPI Code Detail

MEDICARE: DR. CHAD MARTIN BURMEISTER DMD

MEDICARE:  DR. CHAD MARTIN BURMEISTER  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
1122300000XDentistIL

General Provider Information

NPI Number : 1942362348
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHAD MARTIN BURMEISTER DMD
Provider Business Mailing Address
First Line : 758 SPYGLASS CT
Second Line :
City : FORSYTH
State : IL
Zip : 62535
Country : US
Telephone Number : 217-876-9334
Fax Number :
Provider Business Practice Location Address
First Line : 2727 N OAKLAND AVE
Second Line : SUITE 104
City : DECATUR
State : IL
Zip : 62526
Country : US
Telephone Number : 217-875-4555
Fax Number : 217-875-4408
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2006
Last Update Date : 07/08/2007

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Directions to “ DR. CHAD MARTIN BURMEISTER DMD” Practice Location

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