Provider Demographics
NPI:1225417017
Name:JAMES M. BURKART FAMILY DENTISTRY
Entity Type:Organization
Organization Name:JAMES M. BURKART FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-255-0035
Mailing Address - Street 1:13432 MCKINLEY HWY
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-7447
Mailing Address - Country:US
Mailing Address - Phone:574-255-0035
Mailing Address - Fax:574-255-7786
Practice Address - Street 1:13432 MCKINLEY HWY
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-7447
Practice Address - Country:US
Practice Address - Phone:574-255-0035
Practice Address - Fax:574-255-7786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN89651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty