Provider Demographics
NPI:1891468930
Name:THOMAS. J. BURDO, DDS
Entity Type:Organization
Organization Name:THOMAS. J. BURDO, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-784-6377
Mailing Address - Street 1:1100 4 MILE RD. NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49555-7397
Mailing Address - Country:US
Mailing Address - Phone:616-784-6377
Mailing Address - Fax:616-784-8472
Practice Address - Street 1:1100 4 MILE RD. NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49555-7397
Practice Address - Country:US
Practice Address - Phone:616-784-6377
Practice Address - Fax:616-784-8472
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMAS. J. BURDO, DDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty