Brandy Burgess, D.D.S.
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Imperial, MO
NPI 1265625958 · NPPES record last updated Jan 8, 2016
Key facts
- NPI
- 1265625958
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- 2006016233 (MO)
- Practice address
- 1276 Main St
Imperial, MO 63052-3861 - Phone
- (636) 223-7123
- NPI assigned
- Aug 25, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150923001390 | MO | Order and Referring Only - Dentist |
3375850308 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53055 | CA | MD | Marriage & Family Therapist |
| 9818 | CO | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brandy L Burgess, DDS, Ms, LLC | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 53055 | CA | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 9818 | CO | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 2006016233 | MO | Yes |
Addresses
Primary practice location
1276 Main St
Imperial, MO 63052-3861
Mailing address
1276 Main St
Imperial, MO 63052-3861
Phone (636) 223-7123
Other providers in Imperial, MO
- Lindsey Bender
- Stacy Bequette
- Bliss Aesthetics & Wellness Clinic, LLC
- Brandy L Burgess, DDS, Ms, LLC
- Courtney Brophy
- Call of Duty Home Health Care
- Call of Duty Home Health-CDS
- Call of Duty Home Healthcare
- Celso F Rodrigues MD PC
- Antonina Jean Chastain
All providers in Imperial, MO · Orthodontics and Dentofacial Orthopedics Dentistry in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.