Provider Demographics
NPI:1528246535
Name:BURDICK, STEPHEN ALLAN (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ALLAN
Last Name:BURDICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8464 WINNINGHAM
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055
Mailing Address - Country:US
Mailing Address - Phone:713-961-1002
Mailing Address - Fax:713-647-6373
Practice Address - Street 1:8391 WESTVIEW
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055
Practice Address - Country:US
Practice Address - Phone:713-961-1002
Practice Address - Fax:713-647-6373
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist