Healthcare Provider Details

I. General information

NPI: 1912696972
Provider Name (Legal Business Name): ALEX BURR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W JEFFERSON ST
KIRKSVILLE MO
63501-1443
US

IV. Provider business mailing address

1811 E LAHARPE ST
KIRKSVILLE MO
63501-3982
US

V. Phone/Fax

Practice location:
  • Phone: 866-626-2878
  • Fax:
Mailing address:
  • Phone: 307-257-3190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD012857
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: