Provider Demographics
NPI:1144365271
Name:ALVIS BURRIS COSMETIC AND FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:ALVIS BURRIS COSMETIC AND FAMILY DENTISTRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIS
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:BURRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-697-3125
Mailing Address - Street 1:199 SOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:DE
Mailing Address - Zip Code:19934
Mailing Address - Country:US
Mailing Address - Phone:302-697-3125
Mailing Address - Fax:302-697-3640
Practice Address - Street 1:199 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:DE
Practice Address - Zip Code:19934
Practice Address - Country:US
Practice Address - Phone:302-697-3125
Practice Address - Fax:302-697-3640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE949122300000X
DE1179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty