Provider Demographics
NPI:1437726098
Name:BURKE, PERRY JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:JOSEPH
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 1:10275 E COLEMAN RD
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:MI
Mailing Address - Zip Code:48618-9612
Mailing Address - Country:US
Mailing Address - Phone:989-404-0361
Mailing Address - Fax:
Practice Address - Street 1:104 W WHEATON AVE
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-1247
Practice Address - Country:US
Practice Address - Phone:989-386-7021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016008411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice