Organization
QHSA DBA DR. BRADLEY J BURKET DMD, MD
Active
Other names
Dr. Braldey J Burket DMD, MD
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MISTY BOUGHTON (OFFICE MANAGER)
(541) 322-0376
Entity
Organization
Contact information
Practice address
2195 NE PROFESSIONAL CT STE 1, BEND, OR 97701-6028
(541) 322-9396
(541) 322-9398
Mailing address
2195 NE PROFESSIONAL CT STE 1, BEND, OR 97701-6028
(541) 322-9396
(541) 322-9398
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
MD19055
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000BLBYF
—
OR
Enumeration date
04/28/2014
Last updated
04/28/2014
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