Provider Demographics
NPI:1013188176
Name:HUGH F. BURNETT DDS. PA
Entity Type:Organization
Organization Name:HUGH F. BURNETT DDS. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:JENNINGS
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-225-1766
Mailing Address - Street 1:10310 W MARKHAM ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2175
Mailing Address - Country:US
Mailing Address - Phone:501-225-1766
Mailing Address - Fax:501-225-1624
Practice Address - Street 1:10310 W MARKHAM ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2175
Practice Address - Country:US
Practice Address - Phone:501-225-1766
Practice Address - Fax:501-225-1624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR33991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARU91657OtherUPIN
AR5X100OtherARKANSAS BCBS
ARU91657OtherUPIN