MEDICARE: JAMIEK. BURTON, DDS, P.A.

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	122300000X	Dentist	24593	TX

General Provider Information

NPI Number	:	1811308422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMIEK. BURTON, DDS, P.A.

Provider Business Mailing Address
First Line	:	4750 BRYANT IRVIN RD
Second Line	:	SUITE 802
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3633
Country	:	US
Telephone Number	:	817-370-4408
Fax Number	:	817-370-1080

Provider Business Practice Location Address
First Line	:	4750 BRYANT IRVIN RD
Second Line	:	SUITE 802
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3633
Country	:	US
Telephone Number	:	817-370-4408
Fax Number	:	817-370-1080

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMIE K. BURTON
Credential	:	DDS
Telephone Number	:	817-370-4408

Provider Enumeration Date	:	05/16/2014
Last Update Date	:	05/16/2014

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