Provider Demographics
NPI:1730174590
Name:BURROUGHS, JEFFREY R (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:BURROUGHS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 W 119TH ST
Mailing Address - Street 2:STE 215
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3724
Mailing Address - Country:US
Mailing Address - Phone:913-258-5696
Mailing Address - Fax:913-258-5697
Practice Address - Street 1:5525 W 119TH ST
Practice Address - Street 2:STE 215
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3724
Practice Address - Country:US
Practice Address - Phone:913-258-5696
Practice Address - Fax:913-258-5697
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-026760122300000X
NE7054122300000X
KS611351223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist