Provider Demographics
NPI:1376802561
Name:ROBERT BURWELL, DDS, INC.
Entity Type:Organization
Organization Name:ROBERT BURWELL, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-621-0563
Mailing Address - Street 1:2050 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2812
Mailing Address - Country:US
Mailing Address - Phone:909-621-0563
Mailing Address - Fax:909-624-2530
Practice Address - Street 1:2050 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-2812
Practice Address - Country:US
Practice Address - Phone:909-621-0563
Practice Address - Fax:909-624-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD25678261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center