Provider Demographics
NPI:1316371255
Name:BURGESS, ELIZABETH SAUNDERS (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SAUNDERS
Last Name:BURGESS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 HARBOR VIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3201
Mailing Address - Country:US
Mailing Address - Phone:843-795-4255
Mailing Address - Fax:
Practice Address - Street 1:1626 HARBOR VIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3201
Practice Address - Country:US
Practice Address - Phone:843-795-4255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8225122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist