NPI 1003907122

Douglas Wilford Burgess, DDSPA

Practitioner Dentist Mankato, MN

Practice location

Address: 730 Madison Avenue, Mankato, MN 56001
Phone: (507) 625-7550
Fax: (507) 388-3353

Registered specialties

Dentist Primary

Dental Providers Taxonomy 122300000X Licence 7404 (MN)

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Registry record

NPI: 1003907122
Entity type: Individual
Sex (as registered): Male
NPI issued: 27 Sep 2006
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.