Provider Demographics
NPI:1073623823
Name:BURTON, DANIEL JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:BURTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MIDTOWNE NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5713
Mailing Address - Country:US
Mailing Address - Phone:616-784-9150
Mailing Address - Fax:616-784-4468
Practice Address - Street 1:555 MIDTOWNE NE
Practice Address - Street 2:SUITE 104
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5713
Practice Address - Country:US
Practice Address - Phone:616-784-9150
Practice Address - Fax:616-784-4468
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11372122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1073623823Medicare NSC