Provider Demographics
NPI:1013057587
Name:BURDMAN, LAURIE (DDS)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:BURDMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 W AZEELE ST
Mailing Address - Street 2:APT # 430
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3369
Mailing Address - Country:US
Mailing Address - Phone:207-441-6262
Mailing Address - Fax:
Practice Address - Street 1:26851 TANIC DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-1817
Practice Address - Country:US
Practice Address - Phone:813-907-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-172111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice