Provider Demographics
NPI:1912304528
Name:BURRUS DENTISTRY PC
Entity Type:Organization
Organization Name:BURRUS DENTISTRY PC
Other - Org Name:PEDIATRIC DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:POREMSKI
Authorized Official - Last Name:BURRUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-923-8666
Mailing Address - Street 1:413 NW LARCH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1361
Mailing Address - Country:US
Mailing Address - Phone:541-923-8666
Mailing Address - Fax:
Practice Address - Street 1:413 NW LARCH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1361
Practice Address - Country:US
Practice Address - Phone:541-923-8666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty