Provider Demographics
NPI:1780244293
Name:DEVLIN, BURKE ADAM
Entity type:Individual
Prefix:
First Name:BURKE
Middle Name:ADAM
Last Name:DEVLIN
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 1:590 FIRE STATION RD STE C
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4076
Mailing Address - Country:US
Mailing Address - Phone:931-820-2693
Mailing Address - Fax:270-956-0266
Practice Address - Street 1:590 FIRE STATION RD STE C
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4076
Practice Address - Country:US
Practice Address - Phone:270-798-8751
Practice Address - Fax:270-956-0266
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11312122300000X, 122300000X
UT6574972-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist