Provider Demographics
NPI:1942424346
Name:BURNHAM, ARLIE JOACHIM (DDS)
Entity Type:Individual
Prefix:
First Name:ARLIE
Middle Name:JOACHIM
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 1:2021 BATTLECREEK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-5119
Mailing Address - Country:US
Mailing Address - Phone:970-229-0099
Mailing Address - Fax:970-229-1879
Practice Address - Street 1:2021 BATTLECREEK DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528
Practice Address - Country:US
Practice Address - Phone:970-229-0099
Practice Address - Fax:970-229-1879
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO81461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice