Provider Demographics
NPI:1346398518
Name:BURDETT DENTAL, P.C.
Entity Type:Organization
Organization Name:BURDETT DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BURDETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-475-0680
Mailing Address - Street 1:5640 WASATCH DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4902
Mailing Address - Country:US
Mailing Address - Phone:801-475-0680
Mailing Address - Fax:801-475-0685
Practice Address - Street 1:5640 WASATCH DR
Practice Address - Street 2:SUITE D
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4902
Practice Address - Country:US
Practice Address - Phone:801-475-0680
Practice Address - Fax:801-475-0685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2932451223G0001X
UT1315851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529657754001Medicaid