Active NPI
Benjamin Gray Burris, DDS, MDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Orlando, FL
National Provider Identifier
1942302294
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Jan 20, 2025.
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 104
- Practice address
- 837 Good Homes Road
Orlando, FL 32818 - Phone
- (870) 926-5321
- NPI assigned
- Sep 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 13
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | S3-222C | NV | |
| Dentist | 122300000X | 3465 | AR | |
| Dentist | 122300000X | 101237 | CA | |
| Dentist | 122300000X | 109030995 | IL | |
| Dentist | 122300000X | 9869 | KY | |
| Dentist | 122300000X | 6020 | LA | |
| Dentist | 122300000X | 2009033293 | MO | |
| Dentist | 122300000X | 200 | OK | |
| Dentist | 122300000X | 58955 | NY | |
| Dentist | 122300000X | 9071 | TN | |
| Dentist | 122300000X | 25757 | TX | |
| Dentist | 122300000X | 10186273-9921 | UT | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 104 | AR | Primary |
Addresses
Primary practice location
837 Good Homes Road
Orlando, FL 32818
Mailing address
837 Good Homes Road
Orlando, FL 32818
Phone (870) 926-5321
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3465 | AR | MD | Dentist |
| 101237 | CA | MD | Dentist |
| 109030995 | IL | MD | Dentist |
| 9869 | KY | MD | Dentist |
| 2009033293 | MO | MD | Dentist |
| S3-222C | NV | MD | Dentist |
| 58955 | NY | MD | Dentist |
| 10186273-9921 | UT | MD | Dentist |
| 104 | AR | MD | Orthodontics and Dentofacial Orthopedic Dentist |
| 9071 | TN | MD | Pharmacist |
| 25757 | TX | MD | Pharmacist |
| 6020 | LA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516838400000",
"number": "1942302294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "837 GOOD HOMES ROAD",
"city": "ORLANDO",
"state": "FL",
"postal_code": "32818",
"telephone_number": "870-926-5321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "837 GOOD HOMES ROAD",
"city": "ORLANDO",
"state": "FL",
"postal_code": "32818",
"telephone_number": "870-926-5321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURRIS",
"first_name": "BENJAMIN",
"middle_name": "GRAY",
"name_prefix": "Dr.",
"credential": "DDS, MDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-05",
"last_updated": "2018-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NV",
"license": "S3-222C",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AR",
"license": "3465",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "101237",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "109030995",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "9869",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "LA",
"license": "6020",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "2009033293",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OK",
"license": "200",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "58955",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TN",
"license": "9071",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "25757",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "UT",
"license": "10186273-9921",
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "AR",
"license": "104",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.