Individual
DR. AMY ELLIS BURLESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3257
Mailing address
2401 GILLHAM ROAD, PROVIDER ENROLLMENT DEPARTMENT, KANSAS CITY, MO 64108-4619
(816) 701-5200
(816) 302-9939
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2002013150
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100457750A
—
KS
05
—
408970507
—
MO
Enumeration date
09/16/2006
Last updated
05/01/2025
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