Provider Demographics
NPI:1215068739
Name:BURG, VICTORIA DIANA (RDH)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:DIANA
Last Name:BURG
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11832 FM 467
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121
Mailing Address - Country:US
Mailing Address - Phone:830-303-0575
Mailing Address - Fax:
Practice Address - Street 1:6961 HWY 87 EAST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78263
Practice Address - Country:US
Practice Address - Phone:210-648-4411
Practice Address - Fax:210-648-6498
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11993124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist