Provider Demographics
NPI:1609886068
Name:ROBERT H BURCH JR DDS INC
Entity Type:Organization
Organization Name:ROBERT H BURCH JR DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-367-7241
Mailing Address - Street 1:791 ROBERTS DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-5724
Mailing Address - Country:US
Mailing Address - Phone:870-367-7241
Mailing Address - Fax:870-367-1424
Practice Address - Street 1:791 ROBERTS DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-5724
Practice Address - Country:US
Practice Address - Phone:870-367-7241
Practice Address - Fax:870-367-1424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR26931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty