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General NPI Number Information
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NPI Number | 1477283760
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Entity Type | Individual
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Provider Name | JAMES JOSEPH BURRIS DMD
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Gender | Male
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 4241 HWY 14 W
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City | CHRISTOPHER
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State | IL
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Zip | 62822-1037
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Country | US
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Telephone | 619-724-2401
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Fax |
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Provider Business Mailing Address
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Address Line | 8490 EMLING RD
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City | DU QUOIN
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State | IL
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Zip | 62832-3808
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Country | US
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Telephone |
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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 | 019033733
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License Number State | IL
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