Provider Demographics
NPI:1154460863
Name:BURDS, STEPHEN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:BURDS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:1540 HIGH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-3106
Mailing Address - Country:US
Mailing Address - Phone:515-244-9565
Mailing Address - Fax:515-288-7239
Practice Address - Street 1:1540 HIGH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3106
Practice Address - Country:US
Practice Address - Phone:515-244-9565
Practice Address - Fax:515-288-7239
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2008-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA81021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1154460863Medicaid