Provider Demographics
NPI:1548467517
Name:BURGREN, JOAN
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
Last Name:BURGREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W COURT ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-2986
Mailing Address - Country:US
Mailing Address - Phone:530-666-0991
Mailing Address - Fax:530-666-3009
Practice Address - Street 1:255 W COURT ST
Practice Address - Street 2:SUITE E
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-2986
Practice Address - Country:US
Practice Address - Phone:530-666-0991
Practice Address - Fax:530-666-3009
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice