Individual
JONATHAN BURBANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
107 CENTRE SALCELLE BLVD, SUITE 705, YOUNGSVILLE, LA 70592-6352
(337) 451-4636
Mailing address
107 CENTRE SALCELLE BLVD, SUITE 705, YOUNGSVILLE, LA 70592-6352
(337) 451-4636
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6180
LA
Other
Enumeration date
06/01/2011
Last updated
04/07/2014
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