Provider Demographics
NPI:1467670828
Name:BURKE, STEPHEN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:BURKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 PARK RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1310
Mailing Address - Country:US
Mailing Address - Phone:937-643-9434
Mailing Address - Fax:
Practice Address - Street 1:3300 KEMP RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-4200
Practice Address - Country:US
Practice Address - Phone:937-426-6860
Practice Address - Fax:937-426-9703
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300196681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics