Provider Demographics
NPI:1174079891
Name:BURKEEN, JULIE E (DMD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:E
Last Name:BURKEEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:E
Other - Last Name:NILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:11265 NORA LN
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-1760
Mailing Address - Country:US
Mailing Address - Phone:217-855-8705
Mailing Address - Fax:
Practice Address - Street 1:2401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1188
Practice Address - Country:US
Practice Address - Phone:618-997-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0308151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019030815Medicaid