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General NPI Number Information
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NPI Number | 1235287012
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Entity Type | Individual
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Provider Name | SCOTT L BURNETT DDS
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Gender | Male
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 1405 N UNION AVE
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City | ROSWELL
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State | NM
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Zip | 88201-8269
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Country | US
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Telephone | 575-622-2469
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Fax |
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Provider Business Mailing Address
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Address Line | 816 DESI LOOP
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City | BELEN
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State | NM
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Zip | 87002-8026
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Country | US
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Telephone | 406-229-0113
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1843
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DD3989
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License Number State | NM
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