Provider Demographics
NPI:1679654636
Name:BURNELL, DAVID T (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:T
Last Name:BURNELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:D
Other - Last Name:BURNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PRACTICE ADMIN
Mailing Address - Street 1:PO BOX 569
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48139-0569
Mailing Address - Country:US
Mailing Address - Phone:810-231-9630
Mailing Address - Fax:810-231-6329
Practice Address - Street 1:7785 M-36
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:MI
Practice Address - Zip Code:48139-0569
Practice Address - Country:US
Practice Address - Phone:810-231-9630
Practice Address - Fax:810-231-6329
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0134261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice