Organization
BURCHAM DENTAL ARTS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRITT D BURCHAM D.D.S. (PRESIDENT)
(573) 888-3521
Entity
Organization
Contact information
Practice address
205 TEACO RD, KENNETT, MO 63857-3236
(573) 888-3521
(573) 888-0973
Mailing address
205 TEACO RD, P.O. BOX 766, KENNETT, MO 63857-3236
(573) 888-3521
(573) 888-0973
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
015011
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3031860
BLUE CROSS BLUE SHIELD
TN
01
—
856721
UNITED CONCORDIA
—
Enumeration date
07/03/2006
Last updated
12/06/2007
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