Provider Demographics
NPI:1548456692
Name:BURNS FAMILY DENTISTRY
Entity type:Organization
Organization Name:BURNS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE-AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-291-0888
Mailing Address - Street 1:405 LAKE COOK RD STE 208
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4993
Mailing Address - Country:US
Mailing Address - Phone:847-291-0888
Mailing Address - Fax:847-291-1276
Practice Address - Street 1:405 LAKE COOK RD STE 208
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4993
Practice Address - Country:US
Practice Address - Phone:847-291-0888
Practice Address - Fax:847-291-1276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-22
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty