Provider Demographics
NPI:1528215621
Name:BURGHARDT, WILLIAM HOWERTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HOWERTON
Last Name:BURGHARDT
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 1:1851 W 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:FEDERAL HEIGHTS
Mailing Address - State:CO
Mailing Address - Zip Code:80260-5044
Mailing Address - Country:US
Mailing Address - Phone:303-429-6411
Mailing Address - Fax:
Practice Address - Street 1:1851 W 84TH AVE
Practice Address - Street 2:
Practice Address - City:FEDERAL HEIGHTS
Practice Address - State:CO
Practice Address - Zip Code:80260-5044
Practice Address - Country:US
Practice Address - Phone:303-429-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9484122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist