Provider Demographics
NPI:1790856623
Name:BURKE, MELANIE M (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:M
Last Name:BURKE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 YORK ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:410-764-7764
Mailing Address - Fax:443-835-1118
Practice Address - Street 1:1206 YORK ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:410-764-7764
Practice Address - Fax:443-835-1118
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD118311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice