Provider Demographics
NPI:1174688659
Name:BURDICK, ARNIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARNIE
Middle Name:
Last Name:BURDICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 AIRPORT ROAD
Mailing Address - Street 2:GRACE FAMILY DENTISTRY
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-225-6650
Mailing Address - Fax:603-225-9495
Practice Address - Street 1:143 AIRPORT ROAD
Practice Address - Street 2:GRACE FAMILY DENTISTRY
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-225-6650
Practice Address - Fax:603-225-9495
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2389122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30004162Medicaid