Provider Demographics
NPI:1043298417
Name:BURTON, DENNIS M (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:M
Last Name:BURTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22100 BOTHELL EVERETT HWY
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8431
Mailing Address - Country:US
Mailing Address - Phone:208-416-2932
Mailing Address - Fax:
Practice Address - Street 1:5206 SW SAVAGE ST
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-5277
Practice Address - Country:US
Practice Address - Phone:772-678-6225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV133922085N0904X
OH35.0807512085N0904X, 2085R0202X
PAMD4231522085R0202X
GUMTL-2020-0122085R0202X
GUM-22502085R0202X
VA01012391142085R0202X
FLME1069182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001948269Medicaid
WVP00152305OtherRAILROAD MC
OHP00358707OtherRAILROAD MC
OH0675774Medicaid
NC7615108Medicaid
WV0117468000Medicaid
WV0641385Medicare PIN
PA001948269Medicaid
OH4177881Medicare PIN
PA117895W3RMedicare PIN
NC7615108Medicaid