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Kevin D. Burgdorf DDS LLC

Dentist in Bridgeton, MO. Organization (NPI-2).

NPI number1689042467
StatusActive
Last updated in NPPESSep 10, 2015

Details

NPI
1689042467
Entity type
Organization (NPI-2)
Legal business name
Kevin D. Burgdorf DDS LLC
Organization subpart
No
Enumeration date
Sep 10, 2015
Last updated
Sep 10, 2015

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
122300000X Dentist2009008266MOYes

Practice location

12266 Depaul Drive
Suite 325
Bridgeton, MO 63044-2514

Phone 314-291-9000 · Fax 314-291-0590

Mailing address

12266 Depaul Drive
Suite 325
Bridgeton, MO 63044-2514

Phone 314-291-9000 · Fax 314-291-0590

Authorized official

Kevin D Burgdorf
Owner
3142919000

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