Provider Demographics
NPI:1891077236
Name:PAUL BURTON, DDS, PA
Entity Type:Organization
Organization Name:PAUL BURTON, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-227-5200
Mailing Address - Street 1:8116 CANTRELL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-2421
Mailing Address - Country:US
Mailing Address - Phone:501-227-5200
Mailing Address - Fax:501-227-5849
Practice Address - Street 1:8116 CANTRELL RD
Practice Address - Street 2:SUITE C
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-2421
Practice Address - Country:US
Practice Address - Phone:501-227-5200
Practice Address - Fax:501-227-5849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2463261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental