Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DE60569423 | WA |
NPI | 1063848265 |
---|---|
Provider Name | Dr. Kevin Burke |
First Address | Arlington, WA 98223-8461 |
Second Address | Arlington, WA 98223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2013 |
Last Update Date | 06/05/2016 |