Provider Demographics
NPI:1902284573
Name:BURCKHARD ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:BURCKHARD ORTHODONTICS, PLLC
Other - Org Name:BURCKHARD ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCKHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-838-1700
Mailing Address - Street 1:700 WESTERN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3760
Mailing Address - Country:US
Mailing Address - Phone:701-838-1700
Mailing Address - Fax:
Practice Address - Street 1:700 WESTERN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3760
Practice Address - Country:US
Practice Address - Phone:701-838-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2240261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental