Provider Demographics
NPI:1124610126
Name:BURKE CRAWFORD DDS PLLC
Entity type:Organization
Organization Name:BURKE CRAWFORD DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:KYIAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:240-634-9900
Mailing Address - Street 1:8996 BURKE LAKE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8996 BURKE LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1607
Practice Address - Country:US
Practice Address - Phone:703-798-9215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty