Organization
BURLESON ORTHODONTICS AND PEDIATRIC DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DUSTIN BURLESON DDS (ORTHODONTIST, OWNER)
(816) 318-8820
Entity
Organization
Contact information
Practice address
401 LAURUS DR, RAYMORE, MO 64083
(816) 318-8820
Mailing address
401 LAURUS DR, RAYMORE, MO 64083
(816) 318-8820
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
2002013150
MO
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2004013243
MO
Other
Enumeration date
01/12/2012
Last updated
01/12/2012
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