Individual
BRYAN HALL BURDETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MS
Contact information
Practice address
13050 MAGISTERIAL DR, SUITE 100, LOUISVILLE, KY 40223-5180
(502) 245-1061
(502) 245-1065
Mailing address
13050 MAGISTERIAL DR, SUITE 100, LOUISVILLE, KY 40223-5180
(502) 245-1061
(502) 245-1065
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4567
KY
1223G0001X
General Practice Dentistry
4567
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000050182
BC/BS
—
Enumeration date
07/01/2005
Last updated
03/23/2010
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