Provider Demographics
NPI:1205180577
Name:RICHARD M. VANBURK, D.M.D., P.C.
Entity Type:Organization
Organization Name:RICHARD M. VANBURK, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:VANBURK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:217-442-3385
Mailing Address - Street 1:610 N LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-4321
Mailing Address - Country:US
Mailing Address - Phone:217-442-3385
Mailing Address - Fax:217-442-2517
Practice Address - Street 1:610 N LOGAN AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-4321
Practice Address - Country:US
Practice Address - Phone:217-442-3385
Practice Address - Fax:217-442-2517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019016797122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty