MEDICARE: KERIN L. BURDETTE, DDS, LLC

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	261QD0000X	Dental Clinic/Center	5170	AZ
2	261QD0000X	Dental Clinic/Center	015946	MO

General Provider Information

NPI Number	:	1306870597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KERIN L. BURDETTE, DDS, LLC

Provider Business Mailing Address
First Line	:	841 VISTA POINTE DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63138-3849
Country	:	US
Telephone Number	:	314-653-0922
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 NORTHWEST PLZ
Second Line	:	SUITE 524
City	:	SAINT ANN
State	:	MO
Zip	:	63074-2209
Country	:	US
Telephone Number	:	314-739-7900
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. KERIN L. BURDETTE
Credential	:	D.D.S.
Telephone Number	:	314-653-0922

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/22/2020

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