Provider Demographics
NPI:1992778450
Name:BURGER, CARRIE LEE (DDS)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LEE
Last Name:BURGER
Suffix:
Gender:F
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:RTE 12, BLDG 449, ATTN: PROFESSIONAL AFFAIRS
Mailing Address - Street 2:NAVAL HEALTH CARE NEW ENGLAND, GROTON
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06349-5600
Mailing Address - Country:US
Mailing Address - Phone:860-694-2377
Mailing Address - Fax:860-694-2590
Practice Address - Street 1:1173 WHIPPLE RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02841
Practice Address - Country:US
Practice Address - Phone:860-694-2377
Practice Address - Fax:860-694-3590
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10337122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN