Healthcare Provider Details

I. General information

NPI: 1578629606
Provider Name (Legal Business Name): ERIC BURTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 DEVONSHIRE DR
COLUMBIA MO
65203-7035
US

IV. Provider business mailing address

1916 DEVONSHIRE DR
COLUMBIA MO
65203-7035
US

V. Phone/Fax

Practice location:
  • Phone: 573-999-0747
  • Fax:
Mailing address:
  • Phone: 573-999-0747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2003011293
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number2003011293
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2003011293
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: