MEDICARE: PAUL BURTON, DDS, PA

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	261QD0000X	Dental Clinic/Center	2463	AR

General Provider Information

NPI Number	:	1891077236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL BURTON, DDS, PA

Provider Business Mailing Address
First Line	:	8116 CANTRELL RD
Second Line	:	SUITE C
City	:	LITTLE ROCK
State	:	AR
Zip	:	72227-2421
Country	:	US
Telephone Number	:	501-227-5200
Fax Number	:	501-227-5849

Provider Business Practice Location Address
First Line	:	8116 CANTRELL RD
Second Line	:	SUITE C
City	:	LITTLE ROCK
State	:	AR
Zip	:	72227-2421
Country	:	US
Telephone Number	:	501-227-5200
Fax Number	:	501-227-5849

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	STEPHANIE JACKSON
Credential	:
Telephone Number	:	501-227-5200

Provider Enumeration Date	:	09/12/2011
Last Update Date	:	09/12/2011

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