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General NPI Number Information
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NPI Number | 1306870597
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Entity Type | Organization
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Legal Business Name | KERIN L. BURDETTE, DDS, LLC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 500 NORTHWEST PLZ SUITE 524
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City | SAINT ANN
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State | MO
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Zip | 63074-2209
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Country | US
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Telephone | 314-739-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 841 VISTA POINTE DR
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City | SAINT LOUIS
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State | MO
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Zip | 63138-3849
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Country | US
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Telephone | 314-653-0922
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KERIN L. BURDETTE
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Credential | D.D.S.
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Telephone | 314-653-0922
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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 | 5170
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 015946
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License Number State | MO
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