Healthcare Provider Details

I. General information

NPI: 1770368177
Provider Name (Legal Business Name): BRAD R. BURKS, D.M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 E BRADFORD PKWY STE D
SPRINGFIELD MO
65804
US

IV. Provider business mailing address

1355 E BRADFORD PKWY STE D
SPRINGFIELD MO
65804
US

V. Phone/Fax

Practice location:
  • Phone: 417-882-4600
  • Fax: 417-882-1677
Mailing address:
  • Phone: 417-882-4600
  • Fax: 417-882-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. BRAD REESE BURKS
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 417-882-4600