MEDICARE: DR. RICHARD L BURGESS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	13310	TX
2	1223G0001X	General Practice Dentistry	13310	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053463109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD L BURGESS DDS

Provider Business Mailing Address
First Line	:	PO BOX 701047
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78270-1047
Country	:	US
Telephone Number	:	210-532-5461
Fax Number	:

Provider Business Practice Location Address
First Line	:	4721 PECAN VALLEY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-1630
Country	:	US
Telephone Number	:	210-532-5461
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	05/25/2021

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Directions to “ DR. RICHARD L BURGESS DDS” Practice Location

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