Provider Demographics
NPI:1114939550
Name:BURNHAM, ARLIE EUGENE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARLIE
Middle Name:EUGENE
Last Name:BURNHAM
Suffix:JR
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:PO BOX 3125
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-3125
Mailing Address - Country:US
Mailing Address - Phone:719-649-1582
Mailing Address - Fax:719-526-4044
Practice Address - Street 1:19415 SHERWOOD TRL
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-2809
Practice Address - Country:US
Practice Address - Phone:719-649-1582
Practice Address - Fax:719-526-4044
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice