Provider Demographics
NPI:1356891865
Name:BURKE, DAVID ERIK RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ERIK RICHARD
Last Name:BURKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ERIK
Other - Middle Name:
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:KINGSLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49649
Mailing Address - Country:US
Mailing Address - Phone:231-642-2042
Mailing Address - Fax:
Practice Address - Street 1:116 W MAIN ST.
Practice Address - Street 2:
Practice Address - City:KINGSLEY
Practice Address - State:MI
Practice Address - Zip Code:49649
Practice Address - Country:US
Practice Address - Phone:231-642-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2020-02-04
Deactivation Date:2020-01-06
Deactivation Code:
Reactivation Date:2020-02-04
Provider Licenses
StateLicense IDTaxonomies
CA100621122300000X
MI2901021670122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist