Provider Demographics
NPI:1275597700
Name:BURRIS, BRIDGET R (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:R
Last Name:BURRIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1748 S TRIVIZ DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5103
Mailing Address - Country:US
Mailing Address - Phone:505-522-1983
Mailing Address - Fax:505-522-3435
Practice Address - Street 1:1748 S TRIVIZ DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5103
Practice Address - Country:US
Practice Address - Phone:505-522-1983
Practice Address - Fax:505-522-3435
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM15511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice