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General NPI Number Information
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NPI Number | 1811350622
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Entity Type | Organization
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Legal Business Name | WALTER H. BURGESS DMD PC
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Dates
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Enumeration Date | 03/30/2016
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Last Update Date | 04/05/2016
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Provider Practice Location Address
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Address Line | 104 E GUNTER AVE
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City | OPP
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State | AL
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Zip | 36467-1604
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Country | US
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Telephone | 334-493-3501
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Fax | 334-493-3502
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Provider Business Mailing Address
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Address Line | 104 E GUNTER AVE
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City | OPP
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State | AL
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Zip | 36467-1604
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Country | US
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Telephone | 334-493-3501
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Fax | 334-493-3502
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Authorized Official
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Title or Position | DENTIST
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Name | DR. WALTER H BURGESS
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Credential |
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Telephone | 334-493-3501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5538
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License Number State | AL
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