Provider Demographics
NPI:1376592949
Name:BURNETT DDS ORAL & FACIAL SURGERY CENTER OF JOPLIN, P.C.
Entity Type:Organization
Organization Name:BURNETT DDS ORAL & FACIAL SURGERY CENTER OF JOPLIN, P.C.
Other - Org Name:ORAL & FACIAL SURGERY CENTER OF JOPLIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-621-0500
Mailing Address - Street 1:620 W 32ND ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804
Mailing Address - Country:US
Mailing Address - Phone:417-621-0500
Mailing Address - Fax:417-781-5809
Practice Address - Street 1:620 W 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-621-0500
Practice Address - Fax:417-781-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223E0200X, 1223S0112X, 204E00000X, 2082S0099X
MO0107611223E0200X
MO20050057941223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty