Provider Demographics
NPI:1851563423
Name:F. JEROME BURR, DDS, MDS, PLLC
Entity Type:Organization
Organization Name:F. JEROME BURR, DDS, MDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:BURR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDS
Authorized Official - Phone:615-390-1002
Mailing Address - Street 1:1232 CAMP RAVINE RD
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:TN
Mailing Address - Zip Code:37029-5259
Mailing Address - Country:US
Mailing Address - Phone:615-218-7770
Mailing Address - Fax:615-446-6094
Practice Address - Street 1:314 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1832
Practice Address - Country:US
Practice Address - Phone:615-446-6041
Practice Address - Fax:615-446-6094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN82701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441633Medicaid