Provider Demographics
NPI:1952740474
Name:BURKE, THOMAS GERARD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GERARD
Last Name:BURKE
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29001 CEDAR RD
Mailing Address - Street 2:SUITE 453
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4062
Mailing Address - Country:US
Mailing Address - Phone:440-446-1300
Mailing Address - Fax:440-446-0907
Practice Address - Street 1:29001 CEDAR RD
Practice Address - Street 2:SUITE 453
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-4062
Practice Address - Country:US
Practice Address - Phone:614-292-2751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-023959122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist