Provider Demographics
NPI:1154664613
Name:DEAN A BURNETT DDS, MS, PS
Entity Type:Organization
Organization Name:DEAN A BURNETT DDS, MS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:425-641-3300
Mailing Address - Street 1:1200 112TH AVE NE STE C245
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3747
Mailing Address - Country:US
Mailing Address - Phone:425-641-3300
Mailing Address - Fax:425-641-6781
Practice Address - Street 1:1200 112TH AVE NE STE C245
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3747
Practice Address - Country:US
Practice Address - Phone:425-641-3300
Practice Address - Fax:425-641-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA69161223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherDENTIST-ENDODONTIST