Provider Demographics
NPI:1417213034
Name:RONALD S BURNETT DDS PA
Entity Type:Organization
Organization Name:RONALD S BURNETT DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:S
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-972-1200
Mailing Address - Street 1:2500 BROWNS LN STE B
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6107
Mailing Address - Country:US
Mailing Address - Phone:870-972-1200
Mailing Address - Fax:870-932-9746
Practice Address - Street 1:2500 BROWNS LN STE B
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6107
Practice Address - Country:US
Practice Address - Phone:870-972-1200
Practice Address - Fax:870-932-9746
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RONALD S BURNETT DDS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR 2182122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty