Provider Demographics
NPI:1730798570
Name:BURLINGTON ORAL SURGERY
Entity type:Organization
Organization Name:BURLINGTON ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:319-752-2659
Mailing Address - Street 1:1225 S. GEAR AVE.
Mailing Address - Street 2:MERCY PLAZA STE 156
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655
Mailing Address - Country:US
Mailing Address - Phone:319-752-2659
Mailing Address - Fax:319-753-0856
Practice Address - Street 1:1225 S. GEAR AVE.
Practice Address - Street 2:MERCY PLAZA STE 156
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655
Practice Address - Country:US
Practice Address - Phone:319-752-2659
Practice Address - Fax:319-753-0856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty