Provider Demographics
NPI:1265658769
Name:BURTCH, MONTE L (DDS)
Entity Type:Individual
Prefix:
First Name:MONTE
Middle Name:L
Last Name:BURTCH
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 1:557 S ALASKA ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6341
Mailing Address - Country:US
Mailing Address - Phone:907-745-3600
Mailing Address - Fax:907-745-3612
Practice Address - Street 1:557 S ALASKA ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6341
Practice Address - Country:US
Practice Address - Phone:907-745-3600
Practice Address - Fax:907-745-3612
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK8251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice