Provider Demographics
NPI:1891873097
Name:BURROW, WILLIAM HENDERSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HENDERSON
Last Name:BURROW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 NEW MARKET BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5494
Mailing Address - Country:US
Mailing Address - Phone:828-773-4212
Mailing Address - Fax:828-265-2836
Practice Address - Street 1:450 NEW MARKET BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5494
Practice Address - Country:US
Practice Address - Phone:828-773-4212
Practice Address - Fax:828-265-2836
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7991215Medicaid