Provider Demographics
NPI:1225211196
Name:BURROWS, JOHN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:BURROWS
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 1:303 BANCARIO
Mailing Address - Street 2:STE 11-12
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-2825
Mailing Address - Country:US
Mailing Address - Phone:870-739-2992
Mailing Address - Fax:870-739-8597
Practice Address - Street 1:303 BANCARIO
Practice Address - Street 2:STE 11-12
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-2825
Practice Address - Country:US
Practice Address - Phone:870-739-2992
Practice Address - Fax:870-739-8597
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS79831223P0221X
AR36471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR168709608Medicaid
TN5440749Medicaid