=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740401694
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN J BURTON DMD, MS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2007
-----------------------------------------------------
Last Update Date | 04/04/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2640 PATTERSON RD
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81506-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-243-6455
-----------------------------------------------------
Fax | 970-243-1541
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2640 PATTERSON RD
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81506-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-243-6455
-----------------------------------------------------
Fax | 970-243-1541
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 9223
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------