Provider Demographics
NPI:1689990541
Name:BURTON, BRIGHAM KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIGHAM
Middle Name:KENNETH
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 1:2627 N HIGHWAY 162
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84310-9745
Mailing Address - Country:US
Mailing Address - Phone:801-745-3882
Mailing Address - Fax:801-745-6207
Practice Address - Street 1:2627 N HIGHWAY 162
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:UT
Practice Address - Zip Code:84310-9745
Practice Address - Country:US
Practice Address - Phone:801-745-3882
Practice Address - Fax:801-745-6207
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8777026-9923122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program