Provider Demographics
NPI:1245442706
Name:NORMA U. BURNLEY,D.D.S.,D.M.D.,LTD
Entity type:Organization
Organization Name:NORMA U. BURNLEY,D.D.S.,D.M.D.,LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:UBALDE
Authorized Official - Last Name:BURNLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,DMD
Authorized Official - Phone:702-891-0079
Mailing Address - Street 1:5140 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2305
Mailing Address - Country:US
Mailing Address - Phone:702-891-0079
Mailing Address - Fax:702-891-0455
Practice Address - Street 1:5140 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2305
Practice Address - Country:US
Practice Address - Phone:702-891-0079
Practice Address - Fax:702-891-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV885552OtherUNITED CONCORDIA PROVIDER
NV1022OtherSTATE DENTAL LICENSE NO.