Provider Demographics
NPI:1275551129
Name:BURKE FAMILY AND COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:BURKE FAMILY AND COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NHIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-764-1112
Mailing Address - Street 1:6116 ROLLING RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1512
Mailing Address - Country:US
Mailing Address - Phone:703-764-1112
Mailing Address - Fax:703-842-8407
Practice Address - Street 1:6116 ROLLING RD STE 108
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1512
Practice Address - Country:US
Practice Address - Phone:703-764-1112
Practice Address - Fax:703-842-8407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty