Provider Demographics
NPI:1750339206
Name:BURKHARDT, DAVID EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWARD
Last Name:BURKHARDT
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 1:4400 EARLY ST
Mailing Address - Street 2:#10078
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29207-7009
Mailing Address - Country:US
Mailing Address - Phone:803-467-0246
Mailing Address - Fax:
Practice Address - Street 1:1601 ABBEY PLACE
Practice Address - Street 2:SUITE 130, BUILDING 1
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3825
Practice Address - Country:US
Practice Address - Phone:704-512-2510
Practice Address - Fax:704-512-2511
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7726122300000X
WV2618122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist