Provider Demographics
NPI:1114475324
Name:JEFFREY R BURROUGHS DDS LLC
Entity Type:Organization
Organization Name:JEFFREY R BURROUGHS DDS LLC
Other - Org Name:BURROUGHS ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURROUGHS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-686-5601
Mailing Address - Street 1:5525 W 119TH ST STE 215
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3724
Mailing Address - Country:US
Mailing Address - Phone:816-686-5601
Mailing Address - Fax:
Practice Address - Street 1:5525 W 119TH ST STE 215
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3724
Practice Address - Country:US
Practice Address - Phone:816-686-5601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS611351223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty