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General NPI Number Information
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NPI Number | 1457738684
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Entity Type | Organization
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Legal Business Name | GARY BURRIS DDS PC
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Dates
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Enumeration Date | 04/27/2015
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 605 CONGRESS PKWY S
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City | ATHENS
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State | TN
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Zip | 37303-2259
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Country | US
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Telephone | 423-745-2727
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Fax | 423-745-2751
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Provider Business Mailing Address
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Address Line | PO BOX 468
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City | ATHENS
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State | TN
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Zip | 37371-0468
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Country | US
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Telephone | 423-745-2727
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Fax | 423-745-2751
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Authorized Official
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Title or Position | OWNER
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Name | GARY LEE BURRIS
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Credential | DDS
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Telephone | 423-745-2727
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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 | DS0000002699
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License Number State | TN
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