Provider Demographics
NPI:1457738684
Name:GARY BURRIS DDS PC
Entity Type:Organization
Organization Name:GARY BURRIS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BURRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-745-2727
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37371-0468
Mailing Address - Country:US
Mailing Address - Phone:423-745-2727
Mailing Address - Fax:423-745-2751
Practice Address - Street 1:605 CONGRESS PKWY S
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-2259
Practice Address - Country:US
Practice Address - Phone:423-745-2727
Practice Address - Fax:423-745-2751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000002699122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty