Provider Demographics
NPI:1437152493
Name:BURLEIGH DENTAL, SC
Entity Type:Organization
Organization Name:BURLEIGH DENTAL, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOHOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-444-4334
Mailing Address - Street 1:7623 W BURLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-5001
Mailing Address - Country:US
Mailing Address - Phone:414-444-4334
Mailing Address - Fax:414-444-3222
Practice Address - Street 1:7623 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-5001
Practice Address - Country:US
Practice Address - Phone:414-444-4334
Practice Address - Fax:414-444-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2503261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental