Provider Demographics
NPI:1205914140
Name:BURGMAN, SANDRA FURTNER (DDS)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:FURTNER
Last Name:BURGMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 S GEVERS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-5414
Mailing Address - Country:US
Mailing Address - Phone:210-533-6611
Mailing Address - Fax:210-533-6757
Practice Address - Street 1:3402 S GEVERS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-5414
Practice Address - Country:US
Practice Address - Phone:210-533-6611
Practice Address - Fax:210-533-6757
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX782867OtherUNITED CONCORDIA