Provider Demographics
NPI:1730593955
Name:BURCHWOOD
Entity type:Organization
Organization Name:BURCHWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-780-0901
Mailing Address - Street 1:8920 SPENCER HWY STE D
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-4195
Mailing Address - Country:US
Mailing Address - Phone:832-780-0901
Mailing Address - Fax:832-780-0903
Practice Address - Street 1:8920 SPENCER HWY STE D
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-4195
Practice Address - Country:US
Practice Address - Phone:832-780-0901
Practice Address - Fax:832-780-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23093261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental