Provider Demographics
NPI:1538912597
Name:BURCH, JOE GREGORY (DMD)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:GREGORY
Last Name:BURCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 LEDGESTONE DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3521
Mailing Address - Country:US
Mailing Address - Phone:706-612-6956
Mailing Address - Fax:
Practice Address - Street 1:7860 WEST LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-2758
Practice Address - Country:US
Practice Address - Phone:209-235-0295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1099031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice