Provider Demographics
NPI:1649493370
Name:EDWARD C BUREL DDS PC
Entity type:Organization
Organization Name:EDWARD C BUREL DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:BUREL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-254-1570
Mailing Address - Street 1:34 BUCKMAN RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-1406
Mailing Address - Country:US
Mailing Address - Phone:585-254-1570
Mailing Address - Fax:585-458-2700
Practice Address - Street 1:34 BUCKMAN RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-1406
Practice Address - Country:US
Practice Address - Phone:585-254-1570
Practice Address - Fax:585-458-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030811122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7241OtherBLUE CROSS
NY00466835Medicare ID - Type Unspecified