Provider Demographics
NPI:1225653553
Name:BURGESS, DANIELLE K (DDS, MS, MMSC)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:K
Last Name:BURGESS
Suffix:
Gender:F
Credentials:DDS, MS, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5618 LEMMON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-1436
Mailing Address - Country:US
Mailing Address - Phone:954-501-8814
Mailing Address - Fax:
Practice Address - Street 1:5618 LEMMON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-1436
Practice Address - Country:US
Practice Address - Phone:214-506-2969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858715122300000X, 1223P0300X
TX402451223P0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program