Provider Demographics
NPI:1376684019
Name:BURNHEIMER, JOHN MICHAEL (DMD MS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:BURNHEIMER
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 BLOOMFIELD ST STE 103
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3271
Mailing Address - Country:US
Mailing Address - Phone:814-266-1900
Mailing Address - Fax:814-266-4786
Practice Address - Street 1:336 BLOOMFIELD ST STE 103
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3271
Practice Address - Country:US
Practice Address - Phone:814-266-1900
Practice Address - Fax:814-266-4786
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022314L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics