Provider Demographics
NPI:1134240468
Name:BURKE, DENZER (DDS)
Entity type:Individual
Prefix:DR
First Name:DENZER
Middle Name:
Last Name:BURKE
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 1:1421 PINE ST.
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-4413
Mailing Address - Country:US
Mailing Address - Phone:903-794-9741
Mailing Address - Fax:903-794-9741
Practice Address - Street 1:1421 PINE ST.
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-4413
Practice Address - Country:US
Practice Address - Phone:903-794-9741
Practice Address - Fax:903-794-9741
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0072111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD138722OtherCIGNA OFFICE ID
TX0080707Medicaid