Provider Demographics
NPI:1467588384
Name:BURNETT, CHRISTIE RACHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:RACHELLE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHRISTIE
Other - Middle Name:RACHELLE
Other - Last Name:BURNETT-SISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:8540 S SEPULVEDA BLVD STE 710
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3818
Mailing Address - Country:US
Mailing Address - Phone:310-270-8143
Mailing Address - Fax:
Practice Address - Street 1:8540 S SEPULVEDA BLVD STE 710
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3818
Practice Address - Country:US
Practice Address - Phone:310-270-8143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA473521223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD47352OtherDENTICAL