Provider Demographics
NPI:1548356488
Name:BURHOOP, CRAIG NOEL (DDS,PC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:NOEL
Last Name:BURHOOP
Suffix:
Gender:M
Credentials:DDS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 S LAKEPORT ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4509
Mailing Address - Country:US
Mailing Address - Phone:712-276-8391
Mailing Address - Fax:712-276-8403
Practice Address - Street 1:3434 S LAKEPORT ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4509
Practice Address - Country:US
Practice Address - Phone:712-276-8391
Practice Address - Fax:712-276-8403
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA78131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1134288Medicaid