1952456220 NPI number — DR. ANN M. BURWINKEL-MCKENZIE D.D.S.

Table of content: DR. ANN M. BURWINKEL-MCKENZIE D.D.S. (NPI 1952456220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952456220 NPI number — DR. ANN M. BURWINKEL-MCKENZIE D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURWINKEL-MCKENZIE
Provider First Name:
ANN
Provider Middle Name:
M.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURWINKEL
Provider Other First Name:
ANN
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952456220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSBORO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45133-0190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-393-1634
Provider Business Mailing Address Fax Number:
937-393-8509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
323 N HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45133-1173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-393-1634
Provider Business Practice Location Address Fax Number:
937-393-8509
Provider Enumeration Date:
01/24/2007

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: 122300000X , with the licence number:  300-20085 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0984163 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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