Provider Demographics
NPI:1467676528
Name:BURCH, BERNARD EUGENE JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:EUGENE
Last Name:BURCH
Suffix:JR
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 1:17 FOUNTAIN PL
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-1942
Mailing Address - Country:US
Mailing Address - Phone:502-223-1671
Mailing Address - Fax:502-875-4334
Practice Address - Street 1:17 FOUNTAIN PL
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-1942
Practice Address - Country:US
Practice Address - Phone:502-223-1671
Practice Address - Fax:502-875-4334
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice