Basic Information
| Provider Information | |||||||||
| NPI: | 1033559760 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | H. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1326 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OTTAWA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660673527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852424875 | ||||||||
| FaxNumber: | 7852425325 | ||||||||
| Practice Location | |||||||||
| Address1: | 1326 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OTTAWA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660673527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852424875 | ||||||||
| FaxNumber: | 7852425325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2013 | ||||||||
| LastUpdateDate: | 06/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 5996 | KS | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 698738 | 01 | TRICARE | OTHER | 8213 | 01 | KS | BLUE CROSS BLUE SHIELD | OTHER | 12381011 | 01 | BLUE CROSS BLUE SHIELD OF KANSAS CITY | OTHER |