Provider Demographics
NPI:1316669567
Name:DMS OF BURLINGTON, LLC
Entity type:Organization
Organization Name:DMS OF BURLINGTON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:LAINE
Authorized Official - Last Name:DORNBLAZER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:336-228-8159
Mailing Address - Street 1:2960 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9388
Mailing Address - Country:US
Mailing Address - Phone:336-228-8159
Mailing Address - Fax:
Practice Address - Street 1:2960 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9388
Practice Address - Country:US
Practice Address - Phone:336-228-8159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMILY L DORNBLAZER DMD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-14
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty