Provider Demographics
NPI:1942579172
Name:ANDREW M BURT DMD PSC
Entity Type:Organization
Organization Name:ANDREW M BURT DMD PSC
Other - Org Name:BLUEGRASS ORAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MADISON
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-781-6161
Mailing Address - Street 1:546 PARK ST STE 400
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1780
Mailing Address - Country:US
Mailing Address - Phone:270-781-6161
Mailing Address - Fax:
Practice Address - Street 1:546 PARK ST STE 400
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1780
Practice Address - Country:US
Practice Address - Phone:270-781-6161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY72731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty