Provider Demographics
NPI:1295719623
Name:DAVIS, JR., BURIS PARKER (DMD)
Entity type:Individual
Prefix:DR
First Name:BURIS
Middle Name:PARKER
Last Name:DAVIS, JR.
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3367 COUNTY ROAD 73
Mailing Address - Street 2:
Mailing Address - City:NEWVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36353-7084
Mailing Address - Country:US
Mailing Address - Phone:334-889-4537
Mailing Address - Fax:334-792-9336
Practice Address - Street 1:216 HEALTHWEST DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1942
Practice Address - Country:US
Practice Address - Phone:334-792-2880
Practice Address - Fax:334-792-9336
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000001636Medicaid
AL464392OtherUNITED CONCORDIA
AL51091607OtherBCBSAL DOTHAN OFFICE
AL51097734OtherBCBSAL ENTERPRISE OFFICE
AL000091607Medicare ID - Type Unspecified
ALT68683Medicare UPIN