Provider Demographics
NPI:1043589088
Name:BURNS, GROVER PRESTON JR (DENTIST)
Entity Type:Individual
Prefix:
First Name:GROVER
Middle Name:PRESTON
Last Name:BURNS
Suffix:JR
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 BUTLER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2441
Mailing Address - Country:US
Mailing Address - Phone:540-373-6557
Mailing Address - Fax:540-373-6562
Practice Address - Street 1:242 BUTLER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-2441
Practice Address - Country:US
Practice Address - Phone:540-373-6557
Practice Address - Fax:540-373-6562
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010043841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice