Provider Demographics
NPI:1760577613
Name:BURTON, EDWARD A (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
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 1:308 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOCKHART
Mailing Address - State:TX
Mailing Address - Zip Code:78644-2752
Mailing Address - Country:US
Mailing Address - Phone:512-398-6122
Mailing Address - Fax:512-398-2303
Practice Address - Street 1:308 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOCKHART
Practice Address - State:TX
Practice Address - Zip Code:78644-2752
Practice Address - Country:US
Practice Address - Phone:512-398-6122
Practice Address - Fax:512-398-2303
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice