Provider Demographics
NPI:1255751616
Name:ERIC AND CASEY BURNS DDS PA
Entity type:Organization
Organization Name:ERIC AND CASEY BURNS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-799-9059
Mailing Address - Street 1:4914 RANDALL PKWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2879
Mailing Address - Country:US
Mailing Address - Phone:910-799-9059
Mailing Address - Fax:
Practice Address - Street 1:4914 RANDALL PKWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2879
Practice Address - Country:US
Practice Address - Phone:910-799-9059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA79631223G0001X
LA84511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1487733218OtherNPI
NC1992775118OtherNPI
NC5912740Medicaid
275206749OtherTAX ID