Provider Demographics
NPI:1487970406
Name:GUY J BURK DMD LLC
Entity type:Organization
Organization Name:GUY J BURK DMD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD LLC
Authorized Official - Phone:907-360-8516
Mailing Address - Street 1:2805 DAWSON ST
Mailing Address - Street 2:STE 101
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3800
Mailing Address - Country:US
Mailing Address - Phone:907-562-6456
Mailing Address - Fax:907-562-0009
Practice Address - Street 1:2805 DAWSON ST
Practice Address - Street 2:STE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3800
Practice Address - Country:US
Practice Address - Phone:907-562-6456
Practice Address - Fax:907-562-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1270301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty