Provider Demographics
NPI:1275596082
Name:BURKE, JONATHAN E (DMD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:E
Last Name:BURKE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 HURFFVILLE CROSSKEYS RD
Mailing Address - Street 2:UNIT II
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9369
Mailing Address - Country:US
Mailing Address - Phone:856-582-4222
Mailing Address - Fax:856-582-2295
Practice Address - Street 1:449 HURFFVILLE CROSSKEYS RD
Practice Address - Street 2:UNIT II
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9369
Practice Address - Country:US
Practice Address - Phone:856-582-4222
Practice Address - Fax:856-582-2295
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0178411223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ087359TDKMedicare ID - Type Unspecified
NJU46645Medicare UPIN