Provider Demographics
NPI:1356438857
Name:BURKE, DIANNE E (DMD)
Entity type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:E
Last Name:BURKE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2101 EASTERN BLVD
Mailing Address - Street 2:STE. 410
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-1625
Mailing Address - Country:US
Mailing Address - Phone:334-271-0423
Mailing Address - Fax:334-271-0715
Practice Address - Street 1:2101 EASTERN BLVD
Practice Address - Street 2:STE. 410
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-1625
Practice Address - Country:US
Practice Address - Phone:334-271-0423
Practice Address - Fax:334-271-0715
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL39591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-23098Medicare UPIN