Provider Demographics
NPI:1013047935
Name:BURR, MARK LEWIS (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEWIS
Last Name:BURR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2701 DECOTO RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-4940
Mailing Address - Country:US
Mailing Address - Phone:510-489-3400
Mailing Address - Fax:510-489-6770
Practice Address - Street 1:2701 DECOTO RD
Practice Address - Street 2:SUITE 5
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-4940
Practice Address - Country:US
Practice Address - Phone:510-489-3400
Practice Address - Fax:510-489-6770
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA243651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice