Provider Demographics
NPI:1376875773
Name:BURWELL, MICHAEL BRETT (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRETT
Last Name:BURWELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-3359
Mailing Address - Country:US
Mailing Address - Phone:402-563-3631
Mailing Address - Fax:402-563-0520
Practice Address - Street 1:2277 22ND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-3359
Practice Address - Country:US
Practice Address - Phone:402-563-3631
Practice Address - Fax:402-563-0520
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE60671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice