Provider Demographics
NPI:1710358700
Name:BURLEY ENDODONTICS, LLC
Entity Type:Organization
Organization Name:BURLEY ENDODONTICS, LLC
Other - Org Name:WILSONVILLE ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARID
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-570-9090
Mailing Address - Street 1:30485 SW BOONES FERRY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7845
Mailing Address - Country:US
Mailing Address - Phone:503-698-7268
Mailing Address - Fax:
Practice Address - Street 1:30485 SW BOONES FERRY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7845
Practice Address - Country:US
Practice Address - Phone:503-698-7268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD99761223E0200X
ORD91481223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty