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General NPI Number Information
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NPI Number | 1144365271
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Entity Type | Organization
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Legal Business Name | ALVIS BURRIS COSMETIC AND FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 01/16/2019
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Provider Practice Location Address
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Address Line | 199 SOUTH STREET
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City | CAMDEN
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State | DE
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Zip | 19934
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Country | US
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Telephone | 302-697-3125
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Fax | 302-697-3640
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Provider Business Mailing Address
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Address Line | 199 SOUTH STREET
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City | CAMDEN
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State | DE
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Zip | 19934
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Country | US
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Telephone | 302-697-3125
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Fax | 302-697-3640
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALVIS DUANE BURRIS
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Credential | DMD
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Telephone | 302-697-3125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 949
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1179
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License Number State | DE
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