Healthcare Provider Details

I. General information

NPI: 1396446779
Provider Name (Legal Business Name): KIMBERLY ESTELLA BURNHAM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3081 STATE HIGHWAY 31 E
TYLER TX
75702-8620
US

IV. Provider business mailing address

3081 STATE HIGHWAY 31 E
TYLER TX
75702-8620
US

V. Phone/Fax

Practice location:
  • Phone: 361-331-9806
  • Fax:
Mailing address:
  • Phone: 430-351-9849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number39646
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: