# BRYAN HALL BURDETTE

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BRYAN HALL BURDETTE
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1487061081
- **Legal business name:** BRYAN HALL BURDETTE
- **Authorized official:** MRS. WANDA JOAN HAYNES (OFFICE MANAGER)
- **Authorized official phone:** (502) 245-1061

## Contact information

- **Practice address:** 13050 MAGISTERIAL DR, SUITE 100, LOUISVILLE, KY 40223-5180
- **Practice address phone:** (502) 245-1061
- **Practice address fax:** (502) 245-1065
- **Mailing address:** 13050 MAGISTERIAL DR, SUITE 100, LOUISVILLE, KY 40223-5180
- **Mailing address phone:** (502) 245-1061
- **Mailing address fax:** (502) 245-1065

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 03223 | KY | Yes |

## Other

- **Enumeration date:** 07/15/2014
- **Last updated:** 07/15/2014