Provider Demographics
NPI:1538281746
Name:BURKETT AND BURKETT D.D.S.,P.A.
Entity type:Organization
Organization Name:BURKETT AND BURKETT D.D.S.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BURKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-749-6670
Mailing Address - Street 1:104 MILFORD ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6951
Mailing Address - Country:US
Mailing Address - Phone:410-749-6670
Mailing Address - Fax:410-749-2940
Practice Address - Street 1:104 MILFORD ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6951
Practice Address - Country:US
Practice Address - Phone:410-749-6670
Practice Address - Fax:410-749-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD105811223G0001X
MD104911223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty