Provider Demographics
NPI:1194965541
Name:ANDREW M BURT DMD OF MORGANTOWN PLLC
Entity type:Organization
Organization Name:ANDREW M BURT DMD OF MORGANTOWN PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MADISON
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-781-6161
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42261-0415
Mailing Address - Country:US
Mailing Address - Phone:270-526-3346
Mailing Address - Fax:
Practice Address - Street 1:304 MAIN ST.
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261-0415
Practice Address - Country:US
Practice Address - Phone:270-526-3346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY72731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty