Healthcare Provider Details

I. General information

NPI: 1497279004
Provider Name (Legal Business Name): AARON STOWELL BURNETT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 STATE ST
SPRINGFIELD MA
01109-4101
US

IV. Provider business mailing address

15 PARK ST APT 205
SPRINGFIELD MA
01103-2126
US

V. Phone/Fax

Practice location:
  • Phone: 413-736-0027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1857679
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: