Healthcare Provider Details

I. General information

NPI: 1295839306
Provider Name (Legal Business Name): BURTON DENTAL ASSOC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 EAST CASTLE DR SE SUITE D
GRAND RAPIDS MI
49508
US

IV. Provider business mailing address

2013 EAST CASTLE DR SE SUITE D
GRAND RAPIDS MI
49508
US

V. Phone/Fax

Practice location:
  • Phone: 616-455-9900
  • Fax: 616-455-9901
Mailing address:
  • Phone: 616-455-9900
  • Fax: 616-455-9901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901015628
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901017365
License Number StateMI

VIII. Authorized Official

Name: DR. ARETHA YAMUSAH
Title or Position: DDS ,PC
Credential: DDS MPH
Phone: 616-455-9900