Provider Demographics
NPI:1811019607
Name:BURKEY, PAUL S (DDSMS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:BURKEY
Suffix:
Gender:M
Credentials:DDSMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1518
Mailing Address - Country:US
Mailing Address - Phone:847-367-1640
Mailing Address - Fax:847-367-0640
Practice Address - Street 1:290 CENTER DR
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1518
Practice Address - Country:US
Practice Address - Phone:847-367-1640
Practice Address - Fax:847-367-0640
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-0194881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics