Provider Demographics
NPI:1417154287
Name:BURKE, SCOTT E (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:E
Last Name:BURKE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1035
Mailing Address - Country:US
Mailing Address - Phone:207-773-6331
Mailing Address - Fax:207-773-3701
Practice Address - Street 1:650 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1035
Practice Address - Country:US
Practice Address - Phone:207-773-6331
Practice Address - Fax:207-773-3701
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME29541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice