Provider Demographics
NPI:1598956732
Name:BURK JONES, CASIE NICOLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CASIE
Middle Name:NICOLE
Last Name:BURK JONES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 S 6TH STREET RD
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5735
Mailing Address - Country:US
Mailing Address - Phone:217-588-7640
Mailing Address - Fax:217-588-7645
Practice Address - Street 1:5220 S 6TH STREET RD
Practice Address - Street 2:SUITE 2100
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5735
Practice Address - Country:US
Practice Address - Phone:217-588-7640
Practice Address - Fax:217-588-7645
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027440122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist