Provider Demographics
NPI:1780750430
Name:BUERK, BETHEL A (DMD)
Entity type:Individual
Prefix:MRS
First Name:BETHEL
Middle Name:A
Last Name:BUERK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:BETHEL
Other - Middle Name:A
Other - Last Name:RAMSUNDAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:140 E DEAN ST PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:VIRDEN
Mailing Address - State:IL
Mailing Address - Zip Code:62690
Mailing Address - Country:US
Mailing Address - Phone:217-965-3032
Mailing Address - Fax:217-965-4312
Practice Address - Street 1:140 E DEAN ST
Practice Address - Street 2:
Practice Address - City:VIRDEN
Practice Address - State:IL
Practice Address - Zip Code:62690
Practice Address - Country:US
Practice Address - Phone:217-965-3032
Practice Address - Fax:217-965-4312
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist