Active NPI
Samuel Jackson Burrow IV, DDS,DMD
- Orthodontics and Dentofacial Orthopedics Dentistry
- Charlotte, NC
National Provider Identifier
1144653205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 9425
- Practice address
- 2711 Randolph Rd
Suite 600
Charlotte, NC 28207-2034 - Phone
- (704) 334-7202
- Fax
- (704) 372-6974
- NPI assigned
- Aug 13, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 9425 | NC | Primary |
Addresses
Primary practice location
2711 Randolph Rd
Suite 600
Charlotte, NC 28207-2034
Mailing address
2711 Randolph Rd
Suite 600
Charlotte, NC 28207-2034
Phone (704) 334-7202
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9425 | NC | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Burrow, Welchel, Culp & Moore, PLLC | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
| Burrow, Welchel, Culp, Moore PLLC-5 | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Orthodontics and Dentofacial Orthopedics Dentistry
- Charlotte, NC
- NPI 1578785994
-
- Pediatric Dentistry
- Wilmington, NC
- NPI 1780386680
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376352000000",
"number": "1144653205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2711 RANDOLPH RD",
"address_2": "SUITE 600",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282072034",
"telephone_number": "704-334-7202",
"fax_number": "704-372-6974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2711 RANDOLPH RD",
"address_2": "SUITE 600",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282072034",
"telephone_number": "704-334-7202",
"fax_number": "704-372-6974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURROW",
"first_name": "SAMUEL",
"middle_name": "JACKSON",
"name_prefix": "Dr.",
"name_suffix": "IV",
"credential": "DDS,DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-08-13",
"last_updated": "2013-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NC",
"license": "9425",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.