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1154492593
MARK BURGESS
BLOOMINGTON, IL
NPI
1154492593
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1223G0001X Dentist, General Practice
(Licence: IL 19020667)
Enumeration Date
2006-11-09
Last Update Date
2007-07-08
Business Address
Dr. MARK BURGESS DMD
2103 E WASHINGTON ST STE 4B
BLOOMINGTON, IL 61701-4362
Phone number: 309-663-6564
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Mailing Address
Dr. MARK BURGESS DMD
2103 E WASHINGTON ST STE 4B
BLOOMINGTON, IL 61701-4362
Phone number: 309-663-6564
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