Provider Demographics
NPI:1124229984
Name:BURKLAND, GLENN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:A
Last Name:BURKLAND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 E MARSHALL ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-5414
Mailing Address - Country:US
Mailing Address - Phone:610-918-3200
Mailing Address - Fax:
Practice Address - Street 1:440 E MARSHALL ST
Practice Address - Street 2:SUITE 301
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-5414
Practice Address - Country:US
Practice Address - Phone:610-918-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO 180961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics