Individual
DR. JOHN P BURGESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
405 CAPITOL ST, THE PARLOR SUITE, CHARLESTON, WV 25301-1749
(304) 346-4820
(304) 346-4842
Mailing address
405 CAPITOL ST, THE PARLOR SUITE, CHARLESTON, WV 25301-1749
(304) 346-4820
(304) 346-4842
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
WV2776
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0137189000
—
WV
Enumeration date
08/04/2006
Last updated
07/08/2007
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