Provider Demographics
NPI:1780860791
Name:DWAYNE R BURBACH DDS INC
Entity Type:Organization
Organization Name:DWAYNE R BURBACH DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BURBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-466-3328
Mailing Address - Street 1:7005 ATASCADERO AVE
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4431
Mailing Address - Country:US
Mailing Address - Phone:805-466-3328
Mailing Address - Fax:805-466-0824
Practice Address - Street 1:7005 ATASCADERO AVE
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4431
Practice Address - Country:US
Practice Address - Phone:805-466-3328
Practice Address - Fax:805-466-0824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28846261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental