Provider Demographics
NPI:1447430178
Name:BURKE, VERNON (DMD, MD)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:
Last Name:BURKE
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10175 GATEWAY BLVD W
Mailing Address - Street 2:SUITE 304
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7618
Mailing Address - Country:US
Mailing Address - Phone:915-504-6880
Mailing Address - Fax:915-599-8579
Practice Address - Street 1:10175 GATEWAY BLVD W
Practice Address - Street 2:SUITE 304
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7618
Practice Address - Country:US
Practice Address - Phone:915-504-6880
Practice Address - Fax:915-599-8579
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1447430178Medicaid