Provider Demographics
NPI:1093244105
Name:JEFFRY A. BURKE, DMD, PLLC
Entity Type:Organization
Organization Name:JEFFRY A. BURKE, DMD, PLLC
Other - Org Name:DALEVILLE FAMILY DENISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-903-9731
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24083-0204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 TINKER MILL RD
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24083-3716
Practice Address - Country:US
Practice Address - Phone:540-992-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415562261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental