MEDICARE: DR. BRIDGET R BURRIS D.D.S.

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	1223G0001X	General Practice Dentistry	1551	NM

General Provider Information

NPI Number	:	1275597700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIDGET R BURRIS D.D.S.

Provider Business Mailing Address
First Line	:	1748 S TRIVIZ DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-5103
Country	:	US
Telephone Number	:	505-522-1983
Fax Number	:	505-522-3435

Provider Business Practice Location Address
First Line	:	1748 S TRIVIZ DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-5103
Country	:	US
Telephone Number	:	505-522-1983
Fax Number	:	505-522-3435

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. BRIDGET R BURRIS D.D.S.” Practice Location

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