Provider Demographics
NPI:1326213885
Name:BONNIE L BURTON DDS PLLC
Entity Type:Organization
Organization Name:BONNIE L BURTON DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-536-2662
Mailing Address - Street 1:1320 NW HOMESTEAD
Mailing Address - Street 2:SUITE I
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-4202
Mailing Address - Country:US
Mailing Address - Phone:580-536-2662
Mailing Address - Fax:580-536-2226
Practice Address - Street 1:1320 NW HOMESTEAD DR
Practice Address - Street 2:SUITE I
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5288
Practice Address - Country:US
Practice Address - Phone:580-536-2662
Practice Address - Fax:580-536-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4098302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization