Provider Demographics
NPI:1356599237
Name:BURGESS, MYEASHA KHARIMA (DDS)
Entity type:Individual
Prefix:DR
First Name:MYEASHA
Middle Name:KHARIMA
Last Name:BURGESS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 BROADWAY DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7534
Mailing Address - Country:US
Mailing Address - Phone:601-620-0075
Mailing Address - Fax:601-620-0105
Practice Address - Street 1:949 BROADWAY DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7534
Practice Address - Country:US
Practice Address - Phone:601-620-0075
Practice Address - Fax:601-620-0105
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14641122300000X
DCDEN1000754122300000X
OH30.0237951223P0221X
MS3768-141223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist