Provider Demographics
NPI:1891072013
Name:PATRICK S. BURCHFIELD DDS, PC
Entity Type:Organization
Organization Name:PATRICK S. BURCHFIELD DDS, PC
Other - Org Name:SOUTHERN SMILES, FAMILY AND COSMETIC DENTRISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:S
Authorized Official - Last Name:BURCHFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:979-846-7799
Mailing Address - Street 1:4444 CARTER CREEK PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-4467
Mailing Address - Country:US
Mailing Address - Phone:979-846-7799
Mailing Address - Fax:979-268-0178
Practice Address - Street 1:4444 CARTER CREEK PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4467
Practice Address - Country:US
Practice Address - Phone:979-846-7799
Practice Address - Fax:979-268-0178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty