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General NPI Number Information
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NPI Number | 1043424104
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Entity Type | Organization
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Legal Business Name | JERRY L. BURD, DDS, INC.
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3555 DELAWARE ST
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City | BEAUMONT
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State | TX
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Zip | 77706-3033
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Country | US
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Telephone | 409-898-3388
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Fax | 409-898-2673
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Provider Business Mailing Address
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Address Line | 3555 DELAWARE ST
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City | BEAUMONT
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State | TX
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Zip | 77706-3033
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Country | US
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Telephone | 409-898-3388
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Fax | 409-898-2673
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Authorized Official
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Title or Position | PRESIDENT
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Name | JERRY L. BURD
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Credential | DDS
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Telephone | 409-898-3388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 12101
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License Number State | TX
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