Provider Demographics
NPI:1942513569
Name:BURT, GARY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:M
Last Name:BURT
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:1380 112TH AVE NE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3759
Mailing Address - Country:US
Mailing Address - Phone:425-454-2211
Mailing Address - Fax:425-454-9732
Practice Address - Street 1:1380 112TH AVE NE
Practice Address - Street 2:SUITE 203
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3759
Practice Address - Country:US
Practice Address - Phone:425-454-2211
Practice Address - Fax:425-454-9732
Is Sole Proprietor?:No
Enumeration Date:2010-07-24
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WADE000058191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice