Provider Demographics
NPI:1437314085
Name:ROBERT M. BURTON, D.M.D.
Entity Type:Organization
Organization Name:ROBERT M. BURTON, D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-332-1234
Mailing Address - Street 1:197 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2012
Mailing Address - Country:US
Mailing Address - Phone:617-332-1234
Mailing Address - Fax:617-332-1508
Practice Address - Street 1:197 GRANT AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-2012
Practice Address - Country:US
Practice Address - Phone:617-332-1234
Practice Address - Fax:617-332-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty