Provider Demographics
NPI:1144473554
Name:BURKE, DENNIS ALLAN (RDH)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:ALLAN
Last Name:BURKE
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 99117
Mailing Address - Street 2:DETACHMENT 13TH DENTAL COMPANY
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85369-9117
Mailing Address - Country:US
Mailing Address - Phone:928-269-2353
Mailing Address - Fax:928-269-3261
Practice Address - Street 1:2005 KNIGHT LANE
Practice Address - Street 2:BLDG H NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAF
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212-0140
Practice Address - Country:US
Practice Address - Phone:928-269-2353
Practice Address - Fax:928-269-3261
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH4311124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist