Provider Demographics
NPI:1700012036
Name:BURKE, BRIAN T (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:T
Last Name:BURKE
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 1:211 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:QUARRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17566-1122
Mailing Address - Country:US
Mailing Address - Phone:717-786-3104
Mailing Address - Fax:717-786-2653
Practice Address - Street 1:211 W 4TH ST
Practice Address - Street 2:
Practice Address - City:QUARRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:17566-1122
Practice Address - Country:US
Practice Address - Phone:717-786-3104
Practice Address - Fax:717-786-2653
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0383451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice