Individual
DR. BURDETT RUSSELL EDGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
3400 W 16TH ST, BLDG 4-V, GREELEY, CO 80634-6862
(970) 356-5900
(970) 356-2418
Mailing address
3400 W 16TH ST, BLDG 4-V, GREELEY, CO 80634-6862
(970) 356-5900
(970) 356-2418
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
161
CO
Other
Enumeration date
05/08/2007
Last updated
07/08/2007
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