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General NPI Number Information
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NPI Number | 1154560258
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Entity Type | Organization
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Legal Business Name | WALTER H. BURGESS DMD PC
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 03/15/2016
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Provider Practice Location Address
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Address Line | 104 E GUNTER AVE
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City | OPP
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State | AL
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Zip | 36467-1604
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Country | US
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Telephone | 334-493-3501
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Fax | 334-493-3502
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Provider Business Mailing Address
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Address Line | 104 E GUNTER AVE
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City | OPP
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State | AL
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Zip | 36467-1604
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Country | US
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Telephone | 334-493-3501
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Fax | 334-493-3502
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CINDY REED
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Credential |
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Telephone | 334-493-3501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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