Healthcare Provider Details

I. General information

NPI: 1013980564
Provider Name (Legal Business Name): DEAN ALLEN BURNETT D.D.S., M.S., P.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 112TH AVE NE STE C245
BELLEVUE WA
98004-3747
US

IV. Provider business mailing address

1200 112TH AVE NE STE C245
BELLEVUE WA
98004-3747
US

V. Phone/Fax

Practice location:
  • Phone: 425-641-3300
  • Fax: 425-641-6781
Mailing address:
  • Phone: 425-641-3300
  • Fax: 425-641-6781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6916
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: