Provider Demographics
NPI:1982826749
Name:KRISTINE S WEST DDS MS AND DONALD R BURKHARDT DDS MS PC
Entity Type:Organization
Organization Name:KRISTINE S WEST DDS MS AND DONALD R BURKHARDT DDS MS PC
Other - Org Name:WEST AND BURKHARDT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER AND DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:WEST
Authorized Official - Last Name:BURKHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:517-347-0946
Mailing Address - Street 1:4111 OKEMOS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3235
Mailing Address - Country:US
Mailing Address - Phone:517-347-0946
Mailing Address - Fax:517-347-2524
Practice Address - Street 1:4111 OKEMOS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3235
Practice Address - Country:US
Practice Address - Phone:517-347-0946
Practice Address - Fax:517-347-2524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL9407591223X0400X
MIL9407581223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty