Provider Demographics
NPI:1134210057
Name:BURLING, CHARLES KENNETH (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KENNETH
Last Name:BURLING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 RIVERSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047
Mailing Address - Country:US
Mailing Address - Phone:269-782-5161
Mailing Address - Fax:269-782-1126
Practice Address - Street 1:530 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047
Practice Address - Country:US
Practice Address - Phone:269-782-5161
Practice Address - Fax:269-782-1126
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011273122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist