MEDICARE: BRUCE ALAN BURTON DMD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5646	OR

General Provider Information

NPI Number	:	1548515786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE ALAN BURTON DMD PC

Provider Business Mailing Address
First Line	:	1002 10TH ST
Second Line	:	STE 1
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-1564
Country	:	US
Telephone Number	:	541-386-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 10TH ST
Second Line	:	STE 1
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-1564
Country	:	US
Telephone Number	:	541-386-2020
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	CONNIE BURTON
Credential	:
Telephone Number	:	541-386-2020

Provider Enumeration Date	:	07/13/2012
Last Update Date	:	07/13/2012

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