Provider Demographics
NPI:1932321262
Name:CHAD BURMEISTER D.M.D. P.C.
Entity Type:Organization
Organization Name:CHAD BURMEISTER D.M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD PC
Authorized Official - Phone:217-875-4555
Mailing Address - Street 1:2727 N OAKLAND AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526
Mailing Address - Country:US
Mailing Address - Phone:217-875-4555
Mailing Address - Fax:217-233-6792
Practice Address - Street 1:2727 N OAKLAND AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526
Practice Address - Country:US
Practice Address - Phone:217-875-4555
Practice Address - Fax:217-233-6792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019024728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty