Provider Demographics
NPI:1659477727
Name:BURNE, MARK C (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:BURNE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2787 SYCAMORE ST
Mailing Address - Street 2:BUILDING F, SUITE 106
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34289
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2787 SYCAMORE ST
Practice Address - Street 2:BUILDING F, SUITE 106
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34289
Practice Address - Country:US
Practice Address - Phone:941-423-1750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN181661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery