Provider Demographics
NPI:1023452240
Name:BURK, THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:BURK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:TOMMY
Other - Middle Name:
Other - Last Name:BURK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:39 SIMON STREET
Mailing Address - Street 2:UNIT 11-13
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-0599
Mailing Address - Country:US
Mailing Address - Phone:603-883-4008
Mailing Address - Fax:603-881-3822
Practice Address - Street 1:39 SIMON STREET
Practice Address - Street 2:UNIT 11-13
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-0599
Practice Address - Country:US
Practice Address - Phone:603-883-4008
Practice Address - Fax:603-881-3822
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH044771223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery