Provider Demographics
NPI:1518162825
Name:BURTON, JEFFREY TRAVIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:TRAVIS
Last Name:BURTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 SNOWDON CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-4532
Mailing Address - Country:US
Mailing Address - Phone:925-935-1323
Mailing Address - Fax:
Practice Address - Street 1:DVI KASSON RD.
Practice Address - Street 2:DENTAL DEPT
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376
Practice Address - Country:US
Practice Address - Phone:209-835-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice