Provider Demographics
NPI:1346972684
Name:BURKETT, AUSTIN (DMD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:BURKETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 AMESBURY ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1310
Mailing Address - Country:US
Mailing Address - Phone:978-965-3133
Mailing Address - Fax:
Practice Address - Street 1:101 AMESBURY ST STE 102
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1310
Practice Address - Country:US
Practice Address - Phone:978-965-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859440122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist