Provider Demographics
NPI:1710241682
Name:BURGETTE, JACQUELINE (DMD, PHD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BURGETTE
Suffix:
Gender:F
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:HOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3501 TERRACE STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15261-1903
Mailing Address - Country:US
Mailing Address - Phone:412-648-8504
Mailing Address - Fax:412-383-8662
Practice Address - Street 1:3501 TERRACE STREET
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15261-7450
Practice Address - Country:US
Practice Address - Phone:412-648-8504
Practice Address - Fax:412-383-8662
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0412011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry