Provider Demographics
NPI:1255592762
Name:DR.EUGENE BURBACKI DDS, PC
Entity type:Organization
Organization Name:DR.EUGENE BURBACKI DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURBACKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-339-8856
Mailing Address - Street 1:1601 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1340
Mailing Address - Country:US
Mailing Address - Phone:718-339-8856
Mailing Address - Fax:718-339-8740
Practice Address - Street 1:1601 W 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1340
Practice Address - Country:US
Practice Address - Phone:718-339-8856
Practice Address - Fax:718-339-8740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
NY0430581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty