Provider Demographics
NPI:1285854703
Name:BURTENSHAW, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BURTENSHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1662 WINTERBERRY LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-2338
Mailing Address - Country:US
Mailing Address - Phone:954-385-3770
Mailing Address - Fax:
Practice Address - Street 1:2295 S CHAMBERS RD
Practice Address - Street 2:#E
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4544
Practice Address - Country:US
Practice Address - Phone:303-751-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8655122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO85223867Medicaid