Provider Demographics
NPI:1194365643
Name:DENTISTRY AT THE COMMONS
Entity Type:Organization
Organization Name:DENTISTRY AT THE COMMONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURBANK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-250-7079
Mailing Address - Street 1:77 ANGUS RUN
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672-6657
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 PROFESSIONALS CIR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-2669
Practice Address - Country:US
Practice Address - Phone:864-882-0134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental