Provider Demographics
NPI:1063521730
Name:BURPO, TERRY J (DMD)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:J
Last Name:BURPO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:204 N COMMERCE
Mailing Address - City:CRANE
Mailing Address - State:MO
Mailing Address - Zip Code:65633
Mailing Address - Country:US
Mailing Address - Phone:417-723-1723
Mailing Address - Fax:417-723-8540
Practice Address - Street 1:204 N COMMERCE
Practice Address - Street 2:
Practice Address - City:CRANE
Practice Address - State:MO
Practice Address - Zip Code:65633
Practice Address - Country:US
Practice Address - Phone:417-723-1723
Practice Address - Fax:417-723-8540
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE015996122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist