Healthcare Provider Details

I. General information

NPI: 1639422538
Provider Name (Legal Business Name): RODNEY P BURTON DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 LONG CT SUITE 200
THOUSAND OAKS CA
91360-6039
US

IV. Provider business mailing address

75 LONG CT SUITE 200
THOUSAND OAKS CA
91360-6039
US

V. Phone/Fax

Practice location:
  • Phone: 805-494-1500
  • Fax: 805-435-1809
Mailing address:
  • Phone: 805-494-1500
  • Fax: 805-435-1809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number33554
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number33554
License Number StateCA

VIII. Authorized Official

Name: DR. RODNEY P BURTON
Title or Position: PRESIDENT
Credential: DDS
Phone: 805-494-1500