Provider Demographics
NPI:1083765853
Name:POPE-BURNS, SALLY (DMD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:POPE-BURNS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 OLD MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-8926
Mailing Address - Country:US
Mailing Address - Phone:606-759-5401
Mailing Address - Fax:606-759-5783
Practice Address - Street 1:1907 OLD MAIN ST
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-8926
Practice Address - Country:US
Practice Address - Phone:606-759-5401
Practice Address - Fax:606-759-5783
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY67831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY642325OtherUNITED CONCORDIA
KY60067832Medicaid
KY6194309800Medicaid
KY4500384500Medicaid