Provider Demographics
NPI:1043424104
Name:JERRY L. BURD, DDS, INC.
Entity Type:Organization
Organization Name:JERRY L. BURD, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:409-898-3388
Mailing Address - Street 1:3555 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3033
Mailing Address - Country:US
Mailing Address - Phone:409-898-3388
Mailing Address - Fax:409-898-2673
Practice Address - Street 1:3555 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3033
Practice Address - Country:US
Practice Address - Phone:409-898-3388
Practice Address - Fax:409-898-2673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty