Provider Demographics
NPI:1295817450
Name:DR DENNIS BURRELL DDS AND ASSOCIATES, PC
Entity Type:Organization
Organization Name:DR DENNIS BURRELL DDS AND ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-564-7645
Mailing Address - Street 1:4310 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE D
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4337
Mailing Address - Country:US
Mailing Address - Phone:253-564-7645
Mailing Address - Fax:253-566-3449
Practice Address - Street 1:4310 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE D
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4337
Practice Address - Country:US
Practice Address - Phone:253-564-7645
Practice Address - Fax:253-566-3449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000056471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty