Organization
BURGARDT AND DIAZ DENTAL GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GRAYSON JOHN BURGARDT DDS, MSD (MEMBER, MANAGER, AND EMPLOYEE)
(620) 260-5655
Entity
Organization
Contact information
Practice address
13260 N 94TH DR STE 410, PEORIA, AZ 85381-4241
(620) 260-5655
Mailing address
6519 E BLUEFIELD AVE, PHOENIX, AZ 85054-6741
(620) 260-5655
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
06/16/2020
Last updated
07/01/2020
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