MEDICARE: W.L. BURGESS, JR.D.D.S.P.C.

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	2698	TN

General Provider Information

NPI Number	:	1871635185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	W.L. BURGESS, JR.D.D.S.P.C.

Provider Business Mailing Address
First Line	:	8159 WALNUT GROVE RD
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38018-7270
Country	:	US
Telephone Number	:	901-756-8111
Fax Number	:	901-756-8171

Provider Business Practice Location Address
First Line	:	8159 WALNUT GROVE RD
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38018-7270
Country	:	US
Telephone Number	:	901-756-8111
Fax Number	:	901-756-8171

Authorized Official
Title or Position	:	OWNER
Name	:	DR. W L BURGESS JR.
Credential	:	DDS
Telephone Number	:	901-756-8111

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	08/22/2020

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