Provider Demographics
NPI:1376034397
Name:BURTON, BETHANY ANN (DMD)
Entity Type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:ANN
Last Name:BURTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 OAK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4504
Mailing Address - Country:US
Mailing Address - Phone:904-389-3451
Mailing Address - Fax:
Practice Address - Street 1:2522 OAK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4504
Practice Address - Country:US
Practice Address - Phone:904-389-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25919122300000X
OH30025627122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist