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General NPI Number Information
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NPI Number | 1417645227
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Entity Type | Organization
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Legal Business Name | BURGESS FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 04/28/2023
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 18 LEINBACH DR STE E
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City | CHARLESTON
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State | SC
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Zip | 29407-7916
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Country | US
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Telephone | 843-556-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 3 LAVINGTON RD
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City | CHARLESTON
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State | SC
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Zip | 29407-9673
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Country | US
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Telephone | 843-901-3487
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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. ELIZABETH SAUNDERS BURGESS
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Credential | DMD
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Telephone | 843-532-1548
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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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