Provider Demographics
NPI:1194947333
Name:BURGE, VICKIE LOU (DDS)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:LOU
Last Name:BURGE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8851 HAGUE ROAD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1284
Mailing Address - Country:US
Mailing Address - Phone:317-849-8452
Mailing Address - Fax:317-577-1829
Practice Address - Street 1:8851 HAGUE ROAD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1284
Practice Address - Country:US
Practice Address - Phone:317-849-8452
Practice Address - Fax:317-577-1829
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist