Provider Demographics
NPI:1134469570
Name:BURRUP, TRENTON KYLE (DDS)
Entity Type:Individual
Prefix:
First Name:TRENTON
Middle Name:KYLE
Last Name:BURRUP
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 1:2 N MAIN ST STE 405
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6324
Mailing Address - Country:US
Mailing Address - Phone:307-672-7439
Mailing Address - Fax:307-672-7439
Practice Address - Street 1:2 N MAIN ST STE 405
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6324
Practice Address - Country:US
Practice Address - Phone:307-672-7439
Practice Address - Fax:307-672-7439
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY13101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice