Provider Demographics
NPI:1255473435
Name:BURLINGTON DENTAL HEALTH CARE S.C.
Entity Type:Organization
Organization Name:BURLINGTON DENTAL HEALTH CARE S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-763-3012
Mailing Address - Street 1:190 GARDNER AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-2160
Mailing Address - Country:US
Mailing Address - Phone:262-763-3012
Mailing Address - Fax:262-763-4588
Practice Address - Street 1:190 GARDNER AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-2160
Practice Address - Country:US
Practice Address - Phone:262-763-3012
Practice Address - Fax:262-763-4588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5687-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty