Provider Demographics
NPI:1972842037
Name:BURTON, SUSAN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:BURTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 CROSSGATES BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2602
Mailing Address - Country:US
Mailing Address - Phone:601-824-0202
Mailing Address - Fax:601-825-2419
Practice Address - Street 1:365 CROSSGATES BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2602
Practice Address - Country:US
Practice Address - Phone:601-824-0202
Practice Address - Fax:601-825-2419
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2332-87122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist