Provider Demographics
NPI:1598851586
Name:BURKHOLDER, JOHN H (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:BURKHOLDER
Suffix:
Gender:M
Credentials:DMD
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 7425
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94026-7425
Mailing Address - Country:US
Mailing Address - Phone:650-854-3346
Mailing Address - Fax:650-854-4123
Practice Address - Street 1:2095 AVY AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-6030
Practice Address - Country:US
Practice Address - Phone:650-854-3346
Practice Address - Fax:650-854-3346
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA286621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice