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General NPI Number Information
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NPI Number | 1447134960
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Entity Type | Individual
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Provider Name | HALEY NANALINE BURGESS DMD
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Gender | Female
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 1206 HIGHWAY 78 E
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City | JASPER
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State | AL
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Zip | 35501-3939
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Country | US
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Telephone | 205-387-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 408 18TH ST E
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City | JASPER
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State | AL
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Zip | 35501-5456
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Country | US
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Telephone | 706-525-8258
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | D.007537-C1
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License Number State | AL
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