Provider Demographics
NPI:1225056534
Name:BURDYN, WILLIAM E (DMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:BURDYN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519-1620
Mailing Address - Country:US
Mailing Address - Phone:570-489-2232
Mailing Address - Fax:570-489-4203
Practice Address - Street 1:354 MAIN ST
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1620
Practice Address - Country:US
Practice Address - Phone:570-489-2232
Practice Address - Fax:570-489-4203
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO28539L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA44729OtherUNITED CONCORDIA PROVIDER
PA1033888260001Medicaid