Provider Demographics
NPI:1831527571
Name:BURKE DENTAL
Entity type:Organization
Organization Name:BURKE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-978-6000
Mailing Address - Street 1:9006 FERN PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1602
Mailing Address - Country:US
Mailing Address - Phone:703-978-6000
Mailing Address - Fax:703-978-5089
Practice Address - Street 1:9006 FERN PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1602
Practice Address - Country:US
Practice Address - Phone:703-978-6000
Practice Address - Fax:703-978-5089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014126461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty