Individual
DR. MARK BURGESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2103 E WASHINGTON ST STE 4B, BLOOMINGTON, IL 61701-4362
(309) 663-6564
Mailing address
2103 E WASHINGTON ST STE 4B, BLOOMINGTON, IL 61701-4362
(309) 663-6564
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19020667
IL
Other
Enumeration date
11/09/2006
Last updated
07/08/2007
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