Healthcare Provider Details

I. General information

NPI: 1639266570
Provider Name (Legal Business Name): KENT DOUGLAS BURNETT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 NW GRANT AVE
CORVALLIS OR
97330
US

IV. Provider business mailing address

1711 NW GRANT AVE
CORVALLIS OR
97330
US

V. Phone/Fax

Practice location:
  • Phone: 541-754-1668
  • Fax: 541-758-3010
Mailing address:
  • Phone: 541-754-1668
  • Fax: 541-758-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD7437
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD7437
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: