Healthcare Provider Details

I. General information

NPI: 1295719623
Provider Name (Legal Business Name): BURIS PARKER DAVIS, JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 HEALTHWEST DR
DOTHAN AL
36303-1942
US

IV. Provider business mailing address

3367 COUNTY ROAD 73
NEWVILLE AL
36353-7084
US

V. Phone/Fax

Practice location:
  • Phone: 334-792-2880
  • Fax: 334-792-9336
Mailing address:
  • Phone: 334-889-4537
  • Fax: 334-792-9336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2989
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: