Provider Demographics
NPI:1174675912
Name:BURNS, DANIEL A (DDS, MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:BURNS
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46517-3510
Mailing Address - Country:US
Mailing Address - Phone:574-875-0547
Mailing Address - Fax:574-875-0548
Practice Address - Street 1:3807 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-3510
Practice Address - Country:US
Practice Address - Phone:574-875-0547
Practice Address - Fax:574-875-0548
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009601A1223S0112X
IN01048765A204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery