Provider Demographics
NPI:1497538953
Name:BURANDT, CARLIE ANNALISE
Entity Type:Individual
Prefix:
First Name:CARLIE
Middle Name:ANNALISE
Last Name:BURANDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KCU ORAL HEALTH CENTER
Mailing Address - Street 2:3001 ST JOHNS BLVD
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804
Mailing Address - Country:US
Mailing Address - Phone:763-234-2059
Mailing Address - Fax:
Practice Address - Street 1:KCU ORAL HEALTH CENTER
Practice Address - Street 2:3001 ST JOHNS BLVD
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:763-234-2059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program