Provider Demographics
NPI:1578629606
Name:BURTON, ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
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 1:1401 FORUM BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-1915
Mailing Address - Country:US
Mailing Address - Phone:573-446-7181
Mailing Address - Fax:
Practice Address - Street 1:1401 FORUM BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-1915
Practice Address - Country:US
Practice Address - Phone:573-446-7181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003011293122300000X, 1223S0112X, 1223X2210X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X2210XDental ProvidersDentistOrofacial PainGroup - Multi-Specialty