Healthcare Provider Details

I. General information

NPI: 1740401694
Provider Name (Legal Business Name): BRIAN J BURTON DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 PATTERSON RD
GRAND JUNCTION CO
81506-1900
US

IV. Provider business mailing address

2640 PATTERSON RD
GRAND JUNCTION CO
81506-1900
US

V. Phone/Fax

Practice location:
  • Phone: 970-243-6455
  • Fax: 970-243-1541
Mailing address:
  • Phone: 970-243-6455
  • Fax: 970-243-1541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9223
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: