Provider Demographics
NPI:1033162755
Name:BURSTEIN, JEFFREY ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ERIC
Last Name:BURSTEIN
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 1:41074 SEVEN MILE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167
Mailing Address - Country:US
Mailing Address - Phone:248-347-0707
Mailing Address - Fax:248-305-9016
Practice Address - Street 1:41074 SEVEN MILE RD
Practice Address - Street 2:SUITE B
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167
Practice Address - Country:US
Practice Address - Phone:248-347-0707
Practice Address - Fax:248-305-9016
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI13591OtherDENTAL LICENSE NUMBER