Jeremy Wayne Burgin, D.D.S.
Individual provider Active NPI General Practice Dentistry · Clovis, NM
NPI 1891925871 · NPPES record last updated Jul 23, 2009
Key facts
- NPI
- 1891925871
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DD3167 (NM)
- Practice address
- 1800 Sheffield Dr Ste D
Clovis, NM 88101-4946 - Phone
- (575) 714-5055
- Fax
- (575) 762-9573
- NPI assigned
- Jul 23, 2009
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- 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 |
|---|---|---|---|---|
| I20160119000961 | NM | Order and Referring Only - Other (Physician) |
8628371010 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD3167 | NM | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jeremy W Burgin, DDS | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DD3167 | NM | Yes |
Addresses
Primary practice location
1800 Sheffield Dr Ste D
Clovis, NM 88101-4946
Mailing address
1800 Sheffield Dr Ste D
Clovis, NM 88101-4946
Phone (575) 714-5055
Other providers in Clovis, NM
- Clarke A. Brunton Jr.
- Jessica Bryant
- Sarah Grace Bryant
- Tyler Buchanan
- Marla Dianne Buckles
- Brittany Burkhalter
- Amanda Burress
- Larry Bussanmas
- Refugia D Bustamante
- Anthony Bustos
All providers in Clovis, NM · General Practice Dentistry in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2009. 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.