Individual
PETER BURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1094 ROYAL CT, MEDFORD, OR 97504-6138
(541) 779-4344
Mailing address
3227 MCCLOUD ST, MEDFORD, OR 97504-4223
(801) 227-4777
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D-5048
ID
1223G0001X
General Practice Dentistry
Primary
D11073
OR
Other
Enumeration date
07/09/2019
Last updated
07/09/2019
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