Provider Demographics
NPI:1972716199
Name:RICHARD D. BURNS, JR. DDS, MSD, PC
Entity type:Organization
Organization Name:RICHARD D. BURNS, JR. DDS, MSD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:574-875-8196
Mailing Address - Street 1:23618 US HIGHWAY 33
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46517-3608
Mailing Address - Country:US
Mailing Address - Phone:574-875-8196
Mailing Address - Fax:574-875-0581
Practice Address - Street 1:23618 US HIGHWAY 33
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-3608
Practice Address - Country:US
Practice Address - Phone:574-875-8196
Practice Address - Fax:574-875-0581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009006A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty