Provider Demographics
NPI:1225147184
Name:BURKE, ROGER JEROME (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:JEROME
Last Name:BURKE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E NICOLLET BLVD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6734
Mailing Address - Country:US
Mailing Address - Phone:952-435-0370
Mailing Address - Fax:
Practice Address - Street 1:625 E NICOLLET BLVD
Practice Address - Street 2:SUITE 340
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6734
Practice Address - Country:US
Practice Address - Phone:952-435-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN108051223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics