Provider Demographics
NPI:1558575639
Name:BURD, JERRY L (DDS)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:L
Last Name:BURD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3033
Mailing Address - Country:US
Mailing Address - Phone:409-898-3388
Mailing Address - Fax:409-898-2673
Practice Address - Street 1:3555 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3033
Practice Address - Country:US
Practice Address - Phone:409-898-3388
Practice Address - Fax:409-898-2673
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics