Provider Demographics
NPI:1417650722
Name:JOHN MARK BURNEY DDS AND MIA BURNEY, LLC
Entity Type:Organization
Organization Name:JOHN MARK BURNEY DDS AND MIA BURNEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BURNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-513-0013
Mailing Address - Street 1:1750 SAINT CHARLES AVE UNIT CU1
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-6732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1750 SAINT CHARLES AVE UNIT CU1
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-6732
Practice Address - Country:US
Practice Address - Phone:804-513-0013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty