Provider Demographics
NPI:1881641637
Name:BURKETT, BRENDA SLADE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:SLADE
Last Name:BURKETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MILFORD ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6951
Mailing Address - Country:US
Mailing Address - Phone:410-749-6670
Mailing Address - Fax:
Practice Address - Street 1:104 MILFORD ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6951
Practice Address - Country:US
Practice Address - Phone:410-749-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD104911223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics