Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 12009601A | IN |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 01048765A | IN |
NPI | 1174675912 |
---|---|
Provider Name | Daniel A Burns |
First Address | Elkhart, IN 46517-3510 |
Second Address | Elkhart, IN 46517-3510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 30/12/2010 |