Provider Demographics
NPI:1215026174
Name:BURGESS, WILLIAM EARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EARL
Last Name:BURGESS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 S CO RD 300 E
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47220-9704
Mailing Address - Country:US
Mailing Address - Phone:812-358-5650
Mailing Address - Fax:812-358-5650
Practice Address - Street 1:498 S CO RD 300 E
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47220-9704
Practice Address - Country:US
Practice Address - Phone:812-358-5650
Practice Address - Fax:812-358-5650
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006855A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice