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General NPI Number Information
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NPI Number | 1770766388
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Entity Type | Individual
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Provider Name | BRITT D. BURCHAM D.D.S
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Gender | Male
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 05/09/2016
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Provider Practice Location Address
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Address Line | 205 TEACO RD
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City | KENNETT
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State | MO
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Zip | 63857-3236
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Country | US
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Telephone | 573-888-3521
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Fax | 573-888-0973
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Provider Business Mailing Address
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Address Line | 205 TEACO RD P.O. BOX 766
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City | KENNETT
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State | MO
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Zip | 63857-3236
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Country | US
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Telephone | 573-888-3521
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Fax | 573-888-0973
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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 | 15011
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License Number State | MO
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