Provider Demographics
NPI:1760692057
Name:BURNHAM, CRAIG HORSLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:HORSLEY
Last Name:BURNHAM
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 1:430 S ANAHEIM HILLS RD STE F
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4229
Mailing Address - Country:US
Mailing Address - Phone:714-998-1813
Mailing Address - Fax:714-998-1831
Practice Address - Street 1:430 S ANAHEIM HILLS RD
Practice Address - Street 2:STE F
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4229
Practice Address - Country:US
Practice Address - Phone:714-998-1813
Practice Address - Fax:714-998-1831
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26596122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist