Individual
MARK T. BURYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1150 E SHERMAN BLVD, SUITE 1600, MUSKEGON, MI 49444-1871
(231) 733-1571
(231) 733-5228
Mailing address
1150 E SHERMAN BLVD, SUITE 1600, MUSKEGON, MI 49444-1871
(231) 733-1571
(231) 733-5228
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2901013293
MI
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
2901013293
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4863700
—
MI
05
—
4863719
—
MI
01
—
97 0 F11036 0
BLUE CROSS MEDICAL
MI
01
—
D800376
BLUE CROSS DENTAL
MI
Enumeration date
06/29/2006
Last updated
01/26/2010
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