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General NPI Number Information
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NPI Number | 1558505073
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Entity Type | Organization
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Legal Business Name | SUSAN F. BURGESS D.M.D., PC
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Dates
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Enumeration Date | 04/28/2009
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Last Update Date | 05/04/2009
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Provider Practice Location Address
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Address Line | 360 WEST BUTTERFIELD ROAD SUITE 210
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City | ELMHURST
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State | IL
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Zip | 60126-5000
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Country | US
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Telephone | 630-834-2270
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Fax | 630-834-2275
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Provider Business Mailing Address
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Address Line | 360 W. BUTTERFIELD ROAD SUITE 210
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City | ELMHURST
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State | IL
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Zip | 60126-5000
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Country | US
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Telephone | 630-834-2270
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Fax | 630-834-2275
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN F. BURGESS
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Credential | D.M.D.
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Telephone | 630-834-2270
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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 | 019-020251
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License Number State | IL
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