Provider Demographics
NPI:1407872237
Name:BUSKIRK, BURL BERT JR (DDS, MA, CDP)
Entity Type:Individual
Prefix:DR
First Name:BURL
Middle Name:BERT
Last Name:BUSKIRK
Suffix:JR
Gender:M
Credentials:DDS, MA, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 50TH STREET COURT
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8589
Mailing Address - Country:US
Mailing Address - Phone:253-851-4600
Mailing Address - Fax:253-851-4602
Practice Address - Street 1:3214 50TH STREET COURT
Practice Address - Street 2:SUITE 305
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8589
Practice Address - Country:US
Practice Address - Phone:253-851-4600
Practice Address - Fax:253-851-4602
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA43231223G0001X
WACP60058536101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1223G0001XDental ProvidersDentistGeneral Practice