Provider Demographics
NPI:1700922259
Name:BURRISS, WILLIAM BRUCE (DDS, MS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRUCE
Last Name:BURRISS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 W POPLAR AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2579
Mailing Address - Country:US
Mailing Address - Phone:901-853-1568
Mailing Address - Fax:901-853-7406
Practice Address - Street 1:830 W POPLAR AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2579
Practice Address - Country:US
Practice Address - Phone:901-853-1568
Practice Address - Fax:901-853-7406
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000047431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry