Provider Demographics
NPI:1710119177
Name:NORTH PORT ORAL SURGERY INC.
Entity Type:Organization
Organization Name:NORTH PORT ORAL SURGERY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:BURNE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-423-1750
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:941-423-1750
Mailing Address - Fax:941-423-2005
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:941-423-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18166261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental