Provider Demographics
NPI:1609417815
Name:BURT, ARTHUR FARLOW (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:FARLOW
Last Name:BURT
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 1:20081 SE 115TH TER
Mailing Address - Street 2:
Mailing Address - City:INGLIS
Mailing Address - State:FL
Mailing Address - Zip Code:34449-4012
Mailing Address - Country:US
Mailing Address - Phone:727-580-1479
Mailing Address - Fax:
Practice Address - Street 1:7655 W GULF TO LAKE HWY STE 8
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-7910
Practice Address - Country:US
Practice Address - Phone:352-563-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN245811223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health