Provider Demographics
NPI:1376641944
Name:BURKHART, BETTY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:A
Last Name:BURKHART
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:B
Other - Middle Name:A
Other - Last Name:BURKHART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS PC
Mailing Address - Street 1:25110 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48134
Mailing Address - Country:US
Mailing Address - Phone:734-783-5255
Mailing Address - Fax:734-783-5228
Practice Address - Street 1:25110 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48134
Practice Address - Country:US
Practice Address - Phone:734-783-5255
Practice Address - Fax:734-783-5228
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15020122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist