Provider Demographics
NPI:1982784963
Name:BURGDORF, DALE A (DDS)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:A
Last Name:BURGDORF
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 1:6190 LYNDON B JOHNSON FWY
Mailing Address - Street 2:#100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6344
Mailing Address - Country:US
Mailing Address - Phone:972-386-7513
Mailing Address - Fax:972-490-8282
Practice Address - Street 1:6190 LYNDON B JOHNSON FWY
Practice Address - Street 2:#100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6344
Practice Address - Country:US
Practice Address - Phone:972-386-7513
Practice Address - Fax:972-490-8282
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice