Healthcare Provider Details

I. General information

NPI: 1376618371
Provider Name (Legal Business Name): JOHN F BURTON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 RICHLAND MEDICAL PARK DR
COLUMBIA SC
29203-6892
US

IV. Provider business mailing address

10 RICHLAND MEDICAL PARK DR
COLUMBIA SC
29203-6892
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-6567
  • Fax: 803-434-6299
Mailing address:
  • Phone: 803-434-6567
  • Fax: 803-434-6299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number4157
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: