Provider Demographics
NPI:1174501530
Name:BURRIS, TODD C (DMD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:C
Last Name:BURRIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7070 RENNER RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-3047
Mailing Address - Country:US
Mailing Address - Phone:913-268-0888
Mailing Address - Fax:913-268-3752
Practice Address - Street 1:7070 RENNER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-3047
Practice Address - Country:US
Practice Address - Phone:913-268-0888
Practice Address - Fax:913-268-3752
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS601481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200175OtherBCBS OF KS PROVIDER NUMBE
KS32438028OtherBCBS OF KC PROVIDER #