Provider Demographics
NPI:1013389295
Name:BURNEY, JOHN MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARK
Last Name:BURNEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 SAINT CHARLES AVE UNIT CU1
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-6732
Mailing Address - Country:US
Mailing Address - Phone:804-513-0013
Mailing Address - Fax:
Practice Address - Street 1:1750 SAINT CHARLES AVE UNIT CU1
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-6732
Practice Address - Country:US
Practice Address - Phone:804-513-0013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX347871223G0001X
DEG1-00013841223G0001X
NE72681223G0001X
LA71371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice