Provider Demographics
NPI:1306870597
Name:KERIN L. BURDETTE, DDS, LLC
Entity type:Organization
Organization Name:KERIN L. BURDETTE, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KERIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURDETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-653-0922
Mailing Address - Street 1:841 VISTA POINTE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-3849
Mailing Address - Country:US
Mailing Address - Phone:314-653-0922
Mailing Address - Fax:
Practice Address - Street 1:500 NORTHWEST PLZ
Practice Address - Street 2:SUITE 524
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-2209
Practice Address - Country:US
Practice Address - Phone:314-739-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5170261QD0000X
MO015946261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental