Provider Demographics
NPI:1548392426
Name:JOHN BURKE, JR., D.D.S.
Entity Type:Organization
Organization Name:JOHN BURKE, JR., D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-995-7128
Mailing Address - Street 1:3105 LIMESTONE RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2147
Mailing Address - Country:US
Mailing Address - Phone:302-995-7128
Mailing Address - Fax:302-998-2399
Practice Address - Street 1:3105 LIMESTONE RD
Practice Address - Street 2:SUITE 305
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2147
Practice Address - Country:US
Practice Address - Phone:302-995-7128
Practice Address - Fax:302-998-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE8281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000023996Medicaid