Provider Demographics
NPI:1891837258
Name:BURKE, HUGH DERWARD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:HUGH
Middle Name:DERWARD
Last Name:BURKE
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8599 HAVEN AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4849
Mailing Address - Country:US
Mailing Address - Phone:909-945-2342
Mailing Address - Fax:909-948-5474
Practice Address - Street 1:8599 HAVEN AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4849
Practice Address - Country:US
Practice Address - Phone:909-945-2342
Practice Address - Fax:909-948-5474
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA168821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16882OtherDENTAL LICENSE STATE OF C
953661245OtherTIN FED GOVT