Provider Demographics
NPI:1255486528
Name:BURWINKEL, PHILIP ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ANTHONY
Last Name:BURWINKEL
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:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-0190
Mailing Address - Country:US
Mailing Address - Phone:937-393-1634
Mailing Address - Fax:937-393-8509
Practice Address - Street 1:323 N HIGH ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-1173
Practice Address - Country:US
Practice Address - Phone:937-393-1634
Practice Address - Fax:937-393-8509
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300-18490122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0667256Medicaid