=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225887433
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BENJAMIN BURTON DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2024
-----------------------------------------------------
Last Update Date | 07/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 99-128 AIEA HEIGHTS DR STE 201
-----------------------------------------------------
City | AIEA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96701-3916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-484-0888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 SANDGABLES CT
-----------------------------------------------------
City | MACON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31220-8712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-319-4727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 3217
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------