Provider Demographics
NPI:1275764474
Name:BURK, JESSICA M (DMD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:M
Last Name:BURK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:M
Other - Last Name:HAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2805 DAWSON ST. SUITE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503
Mailing Address - Country:US
Mailing Address - Phone:907-562-6456
Mailing Address - Fax:907-562-1002
Practice Address - Street 1:2805 DAWSON ST. SUITE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-562-6456
Practice Address - Fax:907-562-1002
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1309122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist