Provider Demographics
NPI:1639341480
Name:JOHN P. BURKE, D.M.D.,P.C.
Entity Type:Organization
Organization Name:JOHN P. BURKE, D.M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-454-0774
Mailing Address - Street 1:21 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-2228
Mailing Address - Country:US
Mailing Address - Phone:978-454-0774
Mailing Address - Fax:978-934-9993
Practice Address - Street 1:21 GEORGE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2228
Practice Address - Country:US
Practice Address - Phone:978-454-0774
Practice Address - Fax:978-934-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA118541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty