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General NPI Number Information
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NPI Number | 1780878264
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Entity Type | Individual
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Provider Name | JAMES ERIC BURCHETT DDS
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Gender | Male
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 2958 HIGHWAY K
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City | O FALLON
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State | MO
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Zip | 63368-7861
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Country | US
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Telephone | 636-294-5437
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Fax | 636-294-5438
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Provider Business Mailing Address
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Address Line | 1219 SILVER FERN DR
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-4775
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Country | US
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Telephone | 636-294-5437
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Fax | 636-294-5438
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2006032360
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License Number State | MO
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