Provider Demographics
NPI:1740662709
Name:BRIDGET R. BURRIS D. D. S., P. C.
Entity type:Organization
Organization Name:BRIDGET R. BURRIS D. D. S., P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:575-522-1983
Mailing Address - Street 1:1748 S TRIVIZ DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5103
Mailing Address - Country:US
Mailing Address - Phone:575-522-1983
Mailing Address - Fax:575-522-3435
Practice Address - Street 1:1748 S TRIVIZ DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5103
Practice Address - Country:US
Practice Address - Phone:575-522-1983
Practice Address - Fax:575-522-3435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1551261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental