Provider Demographics
NPI:1346628799
Name:BURKE, BRITTANEY NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRITTANEY
Middle Name:NICOLE
Last Name:BURKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W BRONSON DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-7030
Mailing Address - Country:US
Mailing Address - Phone:318-308-1965
Mailing Address - Fax:
Practice Address - Street 1:506 N COURT ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5220
Practice Address - Country:US
Practice Address - Phone:337-942-3441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6553122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist