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General NPI Number Information
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NPI Number | 1417462227
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Entity Type | Organization
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Legal Business Name | ALICIA BURTON DDS PLLC
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Dates
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Enumeration Date | 12/04/2017
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Last Update Date | 12/04/2017
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Provider Practice Location Address
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Address Line | 47 E. WA 902
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City | MEDICAL LAKE
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State | WA
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Zip | 99022
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Country | US
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Telephone | 231-330-3150
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Fax |
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Provider Business Mailing Address
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Address Line | 316 S 11TH ST
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City | COEUR D ALENE
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State | ID
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Zip | 83814-3905
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | ALICIA BURTON
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Credential | DDS
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Telephone | 231-330-3150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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