MEDICARE: DR. DUSTIN BURLESON 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	2004013243	MO

General Provider Information

NPI Number	:	1326078254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUSTIN BURLESON D.D.S.

Provider Business Mailing Address
First Line	:	2940 WALNUT ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-3226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4151 N MULBERRY DR
Second Line	:	SUITE 210
City	:	KANSAS CITY
State	:	MO
Zip	:	64116-1638
Country	:	US
Telephone Number	:	816-741-5311
Fax Number	:	866-253-1590

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

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

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Directions to “ DR. DUSTIN BURLESON D.D.S.” Practice Location

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