Provider Demographics
NPI:1073705885
Name:BURNHAM, JOEL B (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:B
Last Name:BURNHAM
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 1:4848 LAKEVIEW AVE
Mailing Address - Street 2:#102
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3412
Mailing Address - Country:US
Mailing Address - Phone:714-695-9992
Mailing Address - Fax:714-695-9994
Practice Address - Street 1:4848 LAKEVIEW AVE
Practice Address - Street 2:#102
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3412
Practice Address - Country:US
Practice Address - Phone:714-695-9992
Practice Address - Fax:714-695-9994
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28523122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist