Provider Demographics
NPI:1235356122
Name:BURNHAM, CHARLES E JR (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:BURNHAM
Suffix:JR
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:P.O. BOX 12
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-0012
Mailing Address - Country:US
Mailing Address - Phone:252-438-3145
Mailing Address - Fax:252-430-8228
Practice Address - Street 1:900 S. GARNETT ST.
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-0012
Practice Address - Country:US
Practice Address - Phone:252-438-3145
Practice Address - Fax:252-430-8228
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4705122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist