Provider Demographics
NPI:1639664204
Name:BURNETTE, THOMAS ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANDREW
Last Name:BURNETTE
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 1:3111 WENDELL BLVD
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-7272
Mailing Address - Country:US
Mailing Address - Phone:919-365-7416
Mailing Address - Fax:
Practice Address - Street 1:3111 WENDELL BLVD
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591-7272
Practice Address - Country:US
Practice Address - Phone:919-365-7416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist