Provider Demographics
NPI:1770692329
Name:BURCH, DAVID M
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:BURCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MORSE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:30789-4261
Mailing Address - Country:US
Mailing Address - Phone:407-644-4463
Mailing Address - Fax:407-641-4886
Practice Address - Street 1:400 W MORSE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:30789-4261
Practice Address - Country:US
Practice Address - Phone:407-644-4463
Practice Address - Fax:407-641-4886
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN156291223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics