Provider Demographics
NPI:1184498966
Name:BURKE, AMIE (RDH, OMT)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28000 NE 142ND PL SPC 7
Mailing Address - Street 2:
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-8124
Mailing Address - Country:US
Mailing Address - Phone:425-748-4708
Mailing Address - Fax:
Practice Address - Street 1:28000 NE 142ND PL SPC 7
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-8124
Practice Address - Country:US
Practice Address - Phone:425-748-4708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60236343124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist