Provider Demographics
NPI:1134399330
Name:STEPHEN J. BURDS, D.D.S., L.L.C.
Entity type:Organization
Organization Name:STEPHEN J. BURDS, D.D.S., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-244-9565
Mailing Address - Street 1:1540 HIGH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-3106
Mailing Address - Country:US
Mailing Address - Phone:515-244-9565
Mailing Address - Fax:515-288-7239
Practice Address - Street 1:1540 HIGH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3106
Practice Address - Country:US
Practice Address - Phone:515-244-9565
Practice Address - Fax:515-288-7239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA8102122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0476788Medicaid
IA0400149Medicaid
IA0038562Medicaid