Provider Demographics
NPI:1508190422
Name:BRIAN J BURTON DMD MS PC
Entity Type:Organization
Organization Name:BRIAN J BURTON DMD MS PC
Other - Org Name:BURTON ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:970-243-6455
Mailing Address - Street 1:2640 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-1900
Mailing Address - Country:US
Mailing Address - Phone:970-243-6455
Mailing Address - Fax:970-243-1541
Practice Address - Street 1:2640 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-1900
Practice Address - Country:US
Practice Address - Phone:970-243-6455
Practice Address - Fax:970-243-1541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty