Healthcare Provider Details

I. General information

NPI: 1508142811
Provider Name (Legal Business Name): JAMES K BURNHAM DDS, MS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 11TH ST NE
EAST WENATCHEE WA
98802-4481
US

IV. Provider business mailing address

101 11TH ST NE
EAST WENATCHEE WA
98802-4481
US

V. Phone/Fax

Practice location:
  • Phone: 509-886-0664
  • Fax: 509-886-9604
Mailing address:
  • Phone: 509-886-0664
  • Fax: 509-886-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDE00009046
License Number StateWA

VIII. Authorized Official

Name: DR. JAMES K BURNHAM
Title or Position: OWNER/PERIODONTIST
Credential: DDS, MS
Phone: 509-886-0664