| Organization Name: | BURG ORTHODONTICS |
| NPI Number: | 1104233162 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARCI NICOL (VP OF OPERATIONS) |
| Mailing Address: | 3377 Orchard Drive North Salt Lake |
| State: | UT US |
| Postal Code: | 840108005 |
| Phone Number: | 8019518038 |
| Fax Number: | |
| NPI Enumeration Date: | 07/22/2014 |
| NPI Last Update Date: | 07/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |