Provider Demographics
NPI:1821146598
Name:BURGESS, MIGUEL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A
Last Name:BURGESS
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 1:441 DONELSON PIKE
Mailing Address - Street 2:STE 300
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3568
Mailing Address - Country:US
Mailing Address - Phone:615-889-9777
Mailing Address - Fax:615-889-9091
Practice Address - Street 1:113 GRAYLYNN DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-2705
Practice Address - Country:US
Practice Address - Phone:615-889-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN68251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice