Provider Demographics
NPI:1902970098
Name:BURKHART, GARY EUGENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:EUGENE
Last Name:BURKHART
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 RT 611
Mailing Address - Street 2:PO BOX 829
Mailing Address - City:BARTONSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18321
Mailing Address - Country:US
Mailing Address - Phone:570-620-0400
Mailing Address - Fax:570-620-1284
Practice Address - Street 1:99 RT 611
Practice Address - Street 2:
Practice Address - City:BARTONSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18321
Practice Address - Country:US
Practice Address - Phone:570-620-0400
Practice Address - Fax:570-620-1284
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS26241L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice