| Organization Name: | WALTER H. BURGESS DMD PC |
| NPI Number: | 1811350622 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WALTER H BURGESS (DENTIST) |
| Mailing Address: | 104 E Gunter Ave Opp |
| State: | AL US |
| Postal Code: | 364671604 |
| Phone Number: | 3344933501 |
| Fax Number: | 3344933502 |
| NPI Enumeration Date: | 03/30/2016 |
| NPI Last Update Date: | 04/05/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 5538 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |