Provider Demographics
NPI:1558505073
Name:SUSAN F. BURGESS D.M.D., PC
Entity Type:Organization
Organization Name:SUSAN F. BURGESS D.M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-834-2270
Mailing Address - Street 1:360 W. BUTTERFIELD ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5000
Mailing Address - Country:US
Mailing Address - Phone:630-834-2270
Mailing Address - Fax:630-834-2275
Practice Address - Street 1:360 WEST BUTTERFIELD ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5000
Practice Address - Country:US
Practice Address - Phone:630-834-2270
Practice Address - Fax:630-834-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-020251122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty