Provider Demographics
NPI:1114473402
Name:BURGETTE, CHRISTA (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:
Last Name:BURGETTE
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 1:121 DUPLIN PROFESSIONAL COURT
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NC
Mailing Address - Zip Code:28398
Mailing Address - Country:US
Mailing Address - Phone:910-293-4940
Mailing Address - Fax:
Practice Address - Street 1:121 DUPLIN PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NC
Practice Address - Zip Code:28398-8854
Practice Address - Country:US
Practice Address - Phone:910-293-4940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist