Charles M Burgess Jr., DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3319 Issued in AL

Practice address

104 E Gunter Ave
Opp, AL 36467-1604

Phone

(334) 493-3501

Fax

(334) 493-3502

NPI assigned

Oct 25, 2006

Sex

Male

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Walter H. Burgess DMD PC

  • Dental Clinic/Center
  • Opp, AL
  • NPI 1154560258
  NPD (past)
• Walter H. Burgess DMD PC

  • Dental Clinic/Center
  • Opp, AL
  • NPI 1811350622
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649355280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 E GUNTER AVE",
            "city": "OPP",
            "state": "AL",
            "postal_code": "364671604",
            "telephone_number": "334-493-3501",
            "fax_number": "334-493-3502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 E GUNTER AVE",
            "city": "OPP",
            "state": "AL",
            "postal_code": "364671604",
            "telephone_number": "334-493-3501",
            "fax_number": "334-493-3502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGESS",
        "first_name": "CHARLES",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "3319",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000090883",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Jean Basso
• Kenny Ray Blackston, O.D.
• Blissful Healthcare LLC
• Selena Bluck
• Katie Spurlin Bowers, CRNP
• Walter H Burgess, DMD
• Andrew Scott Carter, O.D.
• Joshua Hunter Coon
• Covington County Health Dept-Opp Adult Immun
• Covington County Health Dept-Opp AIDS

• All providers in Opp, AL
• General Practice Dentistry in Alabama

• 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.

Verify at the official NPI Registry.