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General NPI Number Information
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NPI Number | 1952431546
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Entity Type | Individual
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Provider Name | JEFFREY A BURGESS DDS MSD
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Gender | Male
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 735 BISHOP ST SUITE 333
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City | HONOLULU
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State | HI
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Zip | 96813-4817
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Country | US
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Telephone | 800-515-0018
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Fax |
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Provider Business Mailing Address
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Address Line | 2006 NE 63RD ST
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City | SEATTLE
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State | WA
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Zip | 98115-6930
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Country | US
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Telephone | 800-515-0018
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Fax |
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 905
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License Number State | HI
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