MEDICARE: DR. DANIEL S. BURDETT D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	293245	UT

General Provider Information

NPI Number	:	1083762249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL S. BURDETT D.D.S.

Provider Business Mailing Address
First Line	:	5331 ADAMS AVE PKWY
Second Line	:	SUITE C
City	:	OGDEN
State	:	UT
Zip	:	84405-4753
Country	:	US
Telephone Number	:	801-475-0680
Fax Number	:	801-475-0685

Provider Business Practice Location Address
First Line	:	5331 ADAMS AVE PKWY
Second Line	:	SUITE C
City	:	OGDEN
State	:	UT
Zip	:	84405-4753
Country	:	US
Telephone Number	:	801-475-0680
Fax Number	:	801-475-0685

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2007
Last Update Date	:	09/04/2007

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