Provider Demographics
NPI:1578785994
Name:BURROW AND CASE ORTHODONTICS
Entity Type:Organization
Organization Name:BURROW AND CASE ORTHODONTICS
Other - Org Name:BURROW AND CASE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:STUMPF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-334-7202
Mailing Address - Street 1:2711 RANDOLPH RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-2034
Mailing Address - Country:US
Mailing Address - Phone:704-334-7202
Mailing Address - Fax:704-372-2690
Practice Address - Street 1:2711 RANDOLPH RD
Practice Address - Street 2:SUITE 600
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2034
Practice Address - Country:US
Practice Address - Phone:704-334-7202
Practice Address - Fax:704-372-2690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC46171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========Medicare UPIN