Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 0401005266 | VA |
N | 1223P0300X | Periodontist | 0401005266 | VA |
NPI | 1053665505 |
---|---|
Provider Name | Dr. John Arthur Burmeister |
First Address | Midlothian, VA 23114-3174 |
Second Address | Richmond, VA 23298-5013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2012 |
Last Update Date | 06/11/2012 |