1063679926 NPI number — DR. VICTOR HAROLD BURDICK JR. DDS

Table of content: DR. VICTOR HAROLD BURDICK JR. DDS (NPI 1063679926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063679926 NPI number — DR. VICTOR HAROLD BURDICK JR. DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURDICK
Provider First Name:
VICTOR
Provider Middle Name:
HAROLD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063679926
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 W DRY CREEK CIR
Provider Second Line Business Mailing Address:
SUITE 720
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80120-8063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-794-5138
Provider Business Mailing Address Fax Number:
303-794-3599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 W DRY CREEK CIR
Provider Second Line Business Practice Location Address:
SUITE 720
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80120-8063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-794-5138
Provider Business Practice Location Address Fax Number:
303-794-3599
Provider Enumeration Date:
05/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  6175 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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