Provider Demographics
NPI:1629150347
Name:BURTON, DENNIS C (DDS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:C
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 1:263 HOFFMAN RD
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:IL
Mailing Address - Zip Code:61548-9434
Mailing Address - Country:US
Mailing Address - Phone:309-822-0061
Mailing Address - Fax:
Practice Address - Street 1:300 W PEORIA
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-2425
Practice Address - Country:US
Practice Address - Phone:309-444-8481
Practice Address - Fax:309-444-9513
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190204721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice