Provider Demographics
NPI:1073165007
Name:BURNHAM, JOSHUA JOEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:JOEL
Last Name:BURNHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 W 3575 S
Mailing Address - Street 2:
Mailing Address - City:NIBLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6342
Mailing Address - Country:US
Mailing Address - Phone:714-264-6250
Mailing Address - Fax:
Practice Address - Street 1:957 S HWY 89
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5451
Practice Address - Country:US
Practice Address - Phone:714-264-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11349977-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice