Provider Demographics
NPI:1427055391
Name:BURGOS, DANTE R (MD)
Entity type:Individual
Prefix:
First Name:DANTE
Middle Name:R
Last Name:BURGOS
Suffix:
Gender:M
Credentials:MD
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 2022
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-0035
Mailing Address - Country:US
Mailing Address - Phone:972-712-0591
Mailing Address - Fax:972-421-1527
Practice Address - Street 1:6401 ELDORADO PKWY STE 207
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6197
Practice Address - Country:US
Practice Address - Phone:972-712-0591
Practice Address - Fax:972-421-1527
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH85952084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033445003Medicaid
TXTXB109385Medicare PIN