Clyde Walcey Burris, III, D.D.S., P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401008649 Issued in VA

Legal business name

CLYDE WALCEY BURRIS, III, D.D.S., P.C.

Practice address

4950 Greensboro Rd
Ridgeway, VA 24148-3390

Phone

(276) 956-9000

Fax

(276) 956-9002

NPI assigned

May 6, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Clyde Walcey Burris III, D.D.S.

Title

President

Phone

(276) 956-9000

Specialties & licenses 3

Addresses

Other names 1

• C. Walcey Burris, III, D.D.S., P.C. Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Clyde Walcey Burris, III III, D.D.S.

  • General Practice Dentistry
  • Ridgeway, VA
  • NPI 1194066860
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023220365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 483",
            "city": "RIDGEWAY",
            "state": "VA",
            "postal_code": "241480483",
            "telephone_number": "276-956-9000",
            "fax_number": "276-956-9002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4950 GREENSBORO RD",
            "city": "RIDGEWAY",
            "state": "VA",
            "postal_code": "241483390",
            "telephone_number": "276-956-9000",
            "fax_number": "276-956-9002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLYDE WALCEY BURRIS, III, D.D.S., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BURRIS",
        "authorized_official_first_name": "CLYDE",
        "authorized_official_middle_name": "WALCEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "276-956-9000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401008649",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "6657",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "3393",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "C. Walcey Burris, III, D.D.S., P.C.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Makunda Abdul-Mbacke, MD
• Melissa Clark Bolt, LPN
• Clyde Walcey Burris, III III, D.D.S.
• Joanna Lynn Carter, FNP-C
• Chan M Park Family Practice
• Community Alternatives Virginia, Inc.
• Community Alternatives Virginia, Inc.
• Tamiya Davis
• Vanessa Mizelle Eggleston, COTA/L
• Family Preservation Services, Inc

• General Practice Dentistry in Ridgeway, VA
• Providers in Ridgeway, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.