Provider Demographics
NPI:1417645227
Name:BURGESS FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:BURGESS FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:SAUNDERS
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-532-1548
Mailing Address - Street 1:3 LAVINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-9673
Mailing Address - Country:US
Mailing Address - Phone:843-901-3487
Mailing Address - Fax:
Practice Address - Street 1:18 LEINBACH DR STE E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7916
Practice Address - Country:US
Practice Address - Phone:843-556-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental