Provider Demographics
NPI:1336303981
Name:BURNS & BURNS FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BURNS & BURNS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-759-5401
Mailing Address - Street 1:1907 OLD MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-8926
Mailing Address - Country:US
Mailing Address - Phone:606-759-5401
Mailing Address - Fax:
Practice Address - Street 1:1907 OLD MAIN ST
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-8926
Practice Address - Country:US
Practice Address - Phone:606-759-5401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY65761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6194309800Medicaid
KY4500384500Medicaid