Provider Demographics
NPI:1184785511
Name:BURGESS, SUSAN FRANCES (DMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:FRANCES
Last Name:BURGESS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 W BUTTERFIELD RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126
Mailing Address - Country:US
Mailing Address - Phone:630-834-2270
Mailing Address - Fax:630-834-2275
Practice Address - Street 1:360 W BUTTERFIELD RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:630-834-2270
Practice Address - Fax:630-834-2275
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist