Provider Demographics
NPI:1295839306
Name:BURTON DENTAL ASSOC PC
Entity Type:Organization
Organization Name:BURTON DENTAL ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS ,PC
Authorized Official - Prefix:DR
Authorized Official - First Name:ARETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMUSAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MPH
Authorized Official - Phone:616-455-9900
Mailing Address - Street 1:2013 EAST CASTLE DR SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508
Mailing Address - Country:US
Mailing Address - Phone:616-455-9900
Mailing Address - Fax:616-455-9901
Practice Address - Street 1:2013 EAST CASTLE DR SE
Practice Address - Street 2:SUITE D
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508
Practice Address - Country:US
Practice Address - Phone:616-455-9900
Practice Address - Fax:616-455-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017365122300000X
MI2901015628122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty