Provider Demographics
NPI:1255324125
Name:BURNS, JEFFREY A (DMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:BURNS
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 1:933 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4407
Mailing Address - Country:US
Mailing Address - Phone:860-870-4410
Mailing Address - Fax:860-870-2567
Practice Address - Street 1:933 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4407
Practice Address - Country:US
Practice Address - Phone:860-870-4410
Practice Address - Fax:860-870-2567
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT70671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT020007067CT02OtherBLUE CROSS FEDERAL ID #