Individual
DR. SANDRA BURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
3502 W NORTHSIDE DR, JACKSON, MS 39213-4454
(601) 362-5321
Mailing address
3502 W NORTHSIDE DR, JACKSON, MS 39213-4454
(601) 362-5321
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2462-89
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00060237
—
MS
05
—
246289
—
MS
Enumeration date
06/09/2006
Last updated
05/02/2016
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