Healthcare Provider Details

I. General information

NPI: 1538082524
Provider Name (Legal Business Name): ERIC BURNS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 E BELL RD STE 118
PHOENIX AZ
85022-6639
US

IV. Provider business mailing address

702 E BELL RD STE 118
PHOENIX AZ
85022-6639
US

V. Phone/Fax

Practice location:
  • Phone: 602-404-3483
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012591
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: