Provider Demographics
NPI:1427169101
Name:BURROW, SAMUEL JACKSON III (DDS, MS,ABO)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JACKSON
Last Name:BURROW
Suffix:III
Gender:M
Credentials:DDS, MS,ABO
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Mailing Address - Street 1:2711 RANDOLPH RD STE 600
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-2027
Mailing Address - Country:US
Mailing Address - Phone:704-334-7202
Mailing Address - Fax:704-377-6974
Practice Address - Street 1:2711 RANDOLPH RD
Practice Address - Street 2:SUITE 600
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2034
Practice Address - Country:US
Practice Address - Phone:704-334-7202
Practice Address - Fax:704-372-2690
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC46171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics