Provider Demographics
NPI:1013244706
Name:JOHN BURNS PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:JOHN BURNS PROFESSIONAL DENTAL CORPORATION
Other - Org Name:CITY CENTER DENTAL SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:510-763-6300
Mailing Address - Street 1:300 FRANK H OGAWA PLZ
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2037
Mailing Address - Country:US
Mailing Address - Phone:510-763-6300
Mailing Address - Fax:510-625-8300
Practice Address - Street 1:300 FRANK H. OGAWA PLAZA
Practice Address - Street 2:SUITE 100
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612
Practice Address - Country:US
Practice Address - Phone:510-763-6300
Practice Address - Fax:510-625-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA195511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty