Provider Demographics
NPI:1417010273
Name:BURVANT,JR., EDWARD P (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:P
Last Name:BURVANT,JR.
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 OLD LANDING RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-4333
Mailing Address - Country:US
Mailing Address - Phone:985-892-1081
Mailing Address - Fax:985-892-4216
Practice Address - Street 1:601 W 18TH AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3064
Practice Address - Country:US
Practice Address - Phone:985-892-2403
Practice Address - Fax:985-892-4216
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA23471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice