Provider Demographics
NPI:1265585319
Name:BURNS, LINDA ANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ANNE
Last Name:BURNS
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 1:21700 KNOBCONE CT
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:IN
Mailing Address - Zip Code:46507-9689
Mailing Address - Country:US
Mailing Address - Phone:574-848-5985
Mailing Address - Fax:
Practice Address - Street 1:1213 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-3123
Practice Address - Country:US
Practice Address - Phone:574-533-6911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120098111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice