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General NPI Number Information
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NPI Number | 1821255779
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Entity Type | Organization
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Legal Business Name | BURROSS JACKSON RATZLAFF DDS
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 04/18/2011
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Provider Practice Location Address
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Address Line | 5 EUREKA CIR SUITE A
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City | WICHITA FALLS
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State | TX
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Zip | 76308-2900
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Country | US
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Telephone | 940-691-6066
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Fax | 940-691-6068
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Provider Business Mailing Address
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Address Line | 5 EUREKA CIR SUITE A
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City | WICHITA FALLS
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State | TX
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Zip | 76308-2900
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | STEVEN BURROSS
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Credential |
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Telephone | 940-691-6066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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