Provider Demographics
NPI:1124400213
Name:BURKHARDT, JANINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JANINE
Middle Name:
Last Name:BURKHARDT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JANINE
Other - Middle Name:NOELLE
Other - Last Name:MUSHENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2144 CECIL B MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-4014
Mailing Address - Country:US
Mailing Address - Phone:215-320-6187
Mailing Address - Fax:
Practice Address - Street 1:2144 CECIL B MOORE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-4014
Practice Address - Country:US
Practice Address - Phone:215-320-6187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026044001223G0001X
PADS0403631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030223720001Medicaid