Provider Demographics
NPI:1447815931
Name:DR. SHAWN BURL, INC.
Entity type:Organization
Organization Name:DR. SHAWN BURL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DR. SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:205-254-8555
Mailing Address - Street 1:139 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35204-4114
Mailing Address - Country:US
Mailing Address - Phone:205-254-8555
Mailing Address - Fax:
Practice Address - Street 1:139 3RD AVE W
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35204-4114
Practice Address - Country:US
Practice Address - Phone:205-254-8555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4077OtherDENTAL LIC
AL150802Medicaid