Provider Demographics
NPI:1578793923
Name:BURCIAGA, ALEX M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:M
Last Name:BURCIAGA
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 1:73 CAMP ANTELOPE ROAD
Mailing Address - Street 2:
Mailing Address - City:COLEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96107
Mailing Address - Country:US
Mailing Address - Phone:530-495-2100
Mailing Address - Fax:530-495-2122
Practice Address - Street 1:73 CAMP ANTELOPE ROAD
Practice Address - Street 2:
Practice Address - City:COLEVILLE
Practice Address - State:CA
Practice Address - Zip Code:96107
Practice Address - Country:US
Practice Address - Phone:530-495-2100
Practice Address - Fax:530-495-2122
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10096122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist