Provider Demographics
NPI:1770708877
Name:BURKE, ROSALYN L (DDS)
Entity type:Individual
Prefix:
First Name:ROSALYN
Middle Name:L
Last Name:BURKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 CONCORD BLVD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519
Mailing Address - Country:US
Mailing Address - Phone:925-691-0238
Mailing Address - Fax:925-691-0213
Practice Address - Street 1:3600 CONCORD BLVD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519
Practice Address - Country:US
Practice Address - Phone:925-691-0238
Practice Address - Fax:925-691-0213
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist