Provider Demographics
NPI:1629182498
Name:BURTON DENTAL CENTER,PC
Entity Type:Organization
Organization Name:BURTON DENTAL CENTER,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJIVA
Authorized Official - Middle Name:S
Authorized Official - Last Name:TIRTHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-288-6165
Mailing Address - Street 1:103 W CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:MI
Mailing Address - Zip Code:48429
Mailing Address - Country:US
Mailing Address - Phone:989-288-6165
Mailing Address - Fax:989-288-2030
Practice Address - Street 1:103 W CLINTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:DURAND
Practice Address - State:MI
Practice Address - Zip Code:48429
Practice Address - Country:US
Practice Address - Phone:989-288-6165
Practice Address - Fax:989-288-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
D13544122300000X
MI15905201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty