Provider Demographics
NPI:1659455400
Name:BURDINE, JOHN THEODORE (DDS, MSCD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THEODORE
Last Name:BURDINE
Suffix:
Gender:M
Credentials:DDS, MSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 MEMORIAL DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-3422
Mailing Address - Country:US
Mailing Address - Phone:713-688-5200
Mailing Address - Fax:713-688-5212
Practice Address - Street 1:10000 MEMORIAL DR
Practice Address - Street 2:SUITE 410
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-3422
Practice Address - Country:US
Practice Address - Phone:713-688-5200
Practice Address - Fax:713-688-5212
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92891223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics