Provider Demographics
NPI:1427041094
Name:BURROUGHS, ROSIE REDDICK (DMD)
Entity Type:Individual
Prefix:MRS
First Name:ROSIE
Middle Name:REDDICK
Last Name:BURROUGHS
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:PO BOX 1717
Mailing Address - Street 2:715 N LEE ST
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-1717
Mailing Address - Country:US
Mailing Address - Phone:229-928-0545
Mailing Address - Fax:229-928-2567
Practice Address - Street 1:715 N LEE ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31719-3043
Practice Address - Country:US
Practice Address - Phone:229-928-0545
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist