Provider Demographics
NPI:1437230026
Name:BURBACKI, EUGENE (DDS)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:
Last Name:BURBACKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 WEST 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223
Mailing Address - Country:US
Mailing Address - Phone:718-339-8856
Mailing Address - Fax:718-339-8740
Practice Address - Street 1:1601 WEST 6TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223
Practice Address - Country:US
Practice Address - Phone:718-339-8856
Practice Address - Fax:718-339-8740
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2012-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043058122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01223147Medicaid
NY1811103450OtherNPI GROUP PROVIDER