Provider Demographics
NPI:1275810178
Name:BURKETT, EL-CID V (DDS)
Entity Type:Individual
Prefix:DR
First Name:EL-CID
Middle Name:V
Last Name:BURKETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:EL-CID
Other - Middle Name:V
Other - Last Name:BURKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1108 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35217-2267
Mailing Address - Country:US
Mailing Address - Phone:205-441-3428
Mailing Address - Fax:
Practice Address - Street 1:1108 NORTHWOOD DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35217-2267
Practice Address - Country:US
Practice Address - Phone:205-441-3428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8064122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist