Healthcare Provider Details

I. General information

NPI: 1922138072
Provider Name (Legal Business Name): JOHN BARRY BURGESS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 RICE MINE RD NE SUITE A
TUSCALOOSA AL
35406-2401
US

IV. Provider business mailing address

221 RICE MINE RD NE SUITE A
TUSCALOOSA AL
35406-2401
US

V. Phone/Fax

Practice location:
  • Phone: 205-758-3341
  • Fax: 205-758-0846
Mailing address:
  • Phone: 205-758-3341
  • Fax: 205-758-0846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3482
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: