Provider Demographics
NPI:1649357849
Name:BURSON, DYKE WORTH (DDS)
Entity type:Individual
Prefix:DR
First Name:DYKE
Middle Name:WORTH
Last Name:BURSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 NE FAIRGROUNDS RD
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-8609
Mailing Address - Country:US
Mailing Address - Phone:360-698-5868
Mailing Address - Fax:360-698-4777
Practice Address - Street 1:59 NE FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-8609
Practice Address - Country:US
Practice Address - Phone:360-698-5868
Practice Address - Fax:360-698-4777
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA45641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice