=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497908875
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KESHA L. BURNS DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2008
-----------------------------------------------------
Last Update Date | 05/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 513 N THOMPSON LN
-----------------------------------------------------
City | MURFREESBORO
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37129-4313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-439-1949
-----------------------------------------------------
Fax | 615-439-1950
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 513 N THOMPSON LN
-----------------------------------------------------
City | MURFREESBORO
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37129-4313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-439-1949
-----------------------------------------------------
Fax | 615-439-1950
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 9887
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 2008032996
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------