Provider Demographics
NPI:1285930602
Name:BURKE, THOMAS E JR (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:BURKE
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:361 COOPERS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:HEATHSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22473-3504
Mailing Address - Country:US
Mailing Address - Phone:804-580-3860
Mailing Address - Fax:804-580-6220
Practice Address - Street 1:361 COOPERS LANDING RD
Practice Address - Street 2:
Practice Address - City:HEATHSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22473-3504
Practice Address - Country:US
Practice Address - Phone:804-580-3860
Practice Address - Fax:804-580-6220
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010074511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice