Provider Demographics
NPI:1144653205
Name:BURROW, SAMUEL JACKSON IV (DDS,DMD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JACKSON
Last Name:BURROW
Suffix:IV
Gender:M
Credentials:DDS,DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2711 RANDOLPH RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-2034
Mailing Address - Country:US
Mailing Address - Phone:704-334-7202
Mailing Address - Fax:704-372-6974
Practice Address - Street 1:2711 RANDOLPH RD
Practice Address - Street 2:SUITE 600
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2034
Practice Address - Country:US
Practice Address - Phone:704-334-7202
Practice Address - Fax:704-372-6974
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC94251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics