Healthcare Provider Details

I. General information

NPI: 1326213885
Provider Name (Legal Business Name): BONNIE L BURTON DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 NW HOMESTEAD DR SUITE I
LAWTON OK
73505-5288
US

IV. Provider business mailing address

1320 NW HOMESTEAD SUITE I
LAWTON OK
73505-4202
US

V. Phone/Fax

Practice location:
  • Phone: 580-536-2662
  • Fax: 580-536-2226
Mailing address:
  • Phone: 580-536-2662
  • Fax: 580-536-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number4098
License Number StateOK

VIII. Authorized Official

Name: DR. BONNIE L BURTON
Title or Position: OWNER
Credential: DDS
Phone: 580-536-2662