Provider Demographics
NPI:1275631905
Name:BURKE, JEREMY JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:JAMES
Last Name:BURKE
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 1:3234 64TH STREET
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413
Mailing Address - Country:US
Mailing Address - Phone:806-792-2311
Mailing Address - Fax:806-792-8730
Practice Address - Street 1:3234 64TH STREET
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413
Practice Address - Country:US
Practice Address - Phone:806-792-2311
Practice Address - Fax:806-792-8730
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist