Provider Demographics
NPI:1992238950
Name:WILLIAM H. BURGHARDT DDS LLC
Entity type:Organization
Organization Name:WILLIAM H. BURGHARDT DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:BURGHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-319-0070
Mailing Address - Street 1:1899 OCEAN ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-3306
Mailing Address - Country:US
Mailing Address - Phone:781-319-0070
Mailing Address - Fax:
Practice Address - Street 1:1899 OCEAN ST
Practice Address - Street 2:SUITE J
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-3306
Practice Address - Country:US
Practice Address - Phone:781-319-0070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855089122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty