Provider Demographics
NPI:1457306490
Name:BUROCCHI, SHARON LOUISE (DDS PLC)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:LOUISE
Last Name:BUROCCHI
Suffix:
Gender:F
Credentials:DDS PLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 THREE MILE RD NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505
Mailing Address - Country:US
Mailing Address - Phone:616-365-8699
Mailing Address - Fax:616-365-8795
Practice Address - Street 1:2300 THREE MILE RD NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505
Practice Address - Country:US
Practice Address - Phone:616-365-8699
Practice Address - Fax:616-365-8795
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI168131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice