Kristen A Burris, D.D.S.
Individual provider Active NPI General Practice Dentistry · Shattuck, OK
NPI 1811073208 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1811073208
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 4628 (OK)
- Practice address
- 1515 South Main Street
Shattuck, OK 73858 - Phone
- (580) 938-2566
- Fax
- (580) 938-2567
- NPI assigned
- Oct 27, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- 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 |
|---|---|---|---|---|
| I20150715000986 | OK | Order and Referring Only - Oral Surgery |
1355361163 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4628 | OK | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kristen a Burris, D.D.S. L.L.C. | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4628 | OK | Yes |
Addresses
Primary practice location
1515 South Main Street
Shattuck, OK 73858
Mailing address
PO Box 609
Shattuck, OK 73858-0609
Phone (580) 938-2566
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100090140A | Medicaid | OK |
Other providers in Shattuck, OK
- Kerie Bay
- Bryan Wesley Bell
- Jennifer L Berends
- Richard Phillip Berry
- Robert Bradley Bunch
- Amy Calhoun-Vasko
- Jamie L Cameron
- Lorrie Corbin
- John Rodney Cully
- Ellis County EMS
All providers in Shattuck, OK · General Practice Dentistry in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.