Provider Demographics
NPI:1083762249
Name:BURDETT, DANIEL S (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:S
Last Name:BURDETT
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 1:5331 ADAMS AVE PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4753
Mailing Address - Country:US
Mailing Address - Phone:801-475-0680
Mailing Address - Fax:801-475-0685
Practice Address - Street 1:5331 ADAMS AVE PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4753
Practice Address - Country:US
Practice Address - Phone:801-475-0680
Practice Address - Fax:801-475-0685
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2932451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice