Provider Demographics
NPI:1144213752
Name:BURTON, RONALD LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEE
Last Name:BURTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8123
Mailing Address - Country:US
Mailing Address - Phone:770-973-4034
Mailing Address - Fax:770-643-8175
Practice Address - Street 1:1513 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 190
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8123
Practice Address - Country:US
Practice Address - Phone:770-973-4034
Practice Address - Fax:770-643-8175
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA89351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice