Provider Demographics
NPI:1508068289
Name:BURKE, LAWRENCE NEAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:NEAL
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:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58802-0367
Mailing Address - Country:US
Mailing Address - Phone:701-572-2662
Mailing Address - Fax:701-572-0169
Practice Address - Street 1:10 1ST ST E
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-6042
Practice Address - Country:US
Practice Address - Phone:701-572-2662
Practice Address - Fax:701-572-0169
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND16081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND40714Medicaid