Provider Demographics
NPI:1780841593
Name:BURTON, EUGENE H III (DDS)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:H
Last Name:BURTON
Suffix:III
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 1:4300 SONOMA BLVD STE 124
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2205
Mailing Address - Country:US
Mailing Address - Phone:707-643-2500
Mailing Address - Fax:707-643-5206
Practice Address - Street 1:4300 SONOMA BLVD STE 124
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2205
Practice Address - Country:US
Practice Address - Phone:707-643-2500
Practice Address - Fax:707-643-5206
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23804122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist