Active NPI
Timothy R Burgiss, DDS
- General Practice Dentistry
- Union Grove, NC
National Provider Identifier
1043437221
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 5381
- Practice address
- 951 West Memorial Highway
Tri County Medical Park
Union Grove, NC 28689 - Phone
- (704) 539-5544
- Fax
- (704) 539-5209
- NPI assigned
- Apr 19, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5381 | NC | Primary |
Addresses
Primary practice location
951 West Memorial Highway
Tri County Medical Park
Union Grove, NC 28689
Mailing address
PO Box 70
951 West Memorial Highway
Union Grove, NC 28689
Phone (704) 539-5544
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8991185 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5381 | NC | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043437221",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 70",
"address_2": "951 WEST MEMORIAL HIGHWAY",
"city": "UNION GROVE",
"state": "NC",
"postal_code": "28689",
"telephone_number": "704-539-5544",
"fax_number": "704-539-5209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "951 WEST MEMORIAL HIGHWAY",
"address_2": "TRI COUNTY MEDICAL PARK",
"city": "UNION GROVE",
"state": "NC",
"postal_code": "28689",
"telephone_number": "704-539-5544",
"fax_number": "704-539-5209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGISS",
"first_name": "TIMOTHY",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "5381",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8991185",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Union Grove, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.