Provider Demographics
NPI:1104886423
Name:BURCHFIEL, TIMOTHY PAT (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PAT
Last Name:BURCHFIEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 N 129TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-6107
Mailing Address - Country:US
Mailing Address - Phone:402-492-9398
Mailing Address - Fax:402-431-0226
Practice Address - Street 1:628 N 129TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-6107
Practice Address - Country:US
Practice Address - Phone:402-492-9398
Practice Address - Fax:402-431-0226
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE64941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025452300Medicaid