Healthcare Provider Details

I. General information

NPI: 1861886798
Provider Name (Legal Business Name): KIMBALL BURTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 SHEPARD LN STE 200
FARMINGTON UT
84025-2974
US

IV. Provider business mailing address

991 SHEPARD LN STE 100
FARMINGTON UT
84025-2973
US

V. Phone/Fax

Practice location:
  • Phone: 801-737-7437
  • Fax:
Mailing address:
  • Phone: 801-737-7437
  • 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 Code1223P0221X
TaxonomyPediatric Dentistry
License Number10364461-9924
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: