Active NPI
Kelly M Burk
- General Practice Dentistry
- Laurel, MD
National Provider Identifier
1407905417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 11574
- Practice address
- 13916 Baltimore Ave
Laurel, MD 20707-5009 - Phone
- (301) 498-6511
- Fax
- (301) 776-0050
- NPI assigned
- Jan 9, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 11574 | MD | Primary |
Addresses
Primary practice location
13916 Baltimore Ave
Laurel, MD 20707-5009
Mailing address
13916 Baltimore Ave
Laurel, MD 20707-5009
Phone (301) 498-6511
Other names 1
- Dr. Kelly M Burk
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 |
|---|---|---|---|
| 11574 | MD | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407905417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13916 BALTIMORE AVE",
"city": "LAUREL",
"state": "MD",
"postal_code": "207075009",
"telephone_number": "301-498-6511",
"fax_number": "301-776-0050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13916 BALTIMORE AVE",
"city": "LAUREL",
"state": "MD",
"postal_code": "207075009",
"telephone_number": "301-498-6511",
"fax_number": "301-776-0050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURK",
"first_name": "KELLY",
"middle_name": "M",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MD",
"license": "11574",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KELLY",
"last_name": "BURK",
"middle_name": "M",
"prefix": "DR.",
"credential": "DDS",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Laurel, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.