Provider Demographics
NPI:1144302274
Name:GROVER PRESTON BURNS,JR.,D.D.S.,P.C.
Entity type:Organization
Organization Name:GROVER PRESTON BURNS,JR.,D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GROVER
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-373-6557
Mailing Address - Street 1:242 BUTLER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2441
Mailing Address - Country:US
Mailing Address - Phone:540-373-6557
Mailing Address - Fax:
Practice Address - Street 1:242 BUTLER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-2441
Practice Address - Country:US
Practice Address - Phone:540-373-6557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010043841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty