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Organization
BURGARDT AND DIAZ DENTAL GROUP, PLLC
Active
Organization
BURGARDT AND DIAZ DENTAL GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GRAYSON JOHN BURGARDT DDS, MSD (MEMBER, MANAGER, AND EMPLOYEE)
(620) 260-5655
Entity
Organization
Contact information
Practice address
13260 N 94TH DR STE 410, PEORIA, AZ 85381-4241
(620) 260-5655
Mailing address
6519 E BLUEFIELD AVE, PHOENIX, AZ 85054-6741
(620) 260-5655
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
06/16/2020
Last updated
07/01/2020
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