Provider Demographics
NPI:1962506113
Name:BURLINGAME DENTAL ARTS
Entity Type:Organization
Organization Name:BURLINGAME DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:T
Authorized Official - Last Name:LORENZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-246-8447
Mailing Address - Street 1:7471 SW BARBUR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2809
Mailing Address - Country:US
Mailing Address - Phone:503-246-8447
Mailing Address - Fax:503-245-6631
Practice Address - Street 1:7471 SW BARBUR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2809
Practice Address - Country:US
Practice Address - Phone:503-246-8447
Practice Address - Fax:503-245-6631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-09
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR63361223G0001X
OR63441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty