Provider Demographics
NPI:1124312988
Name:BURNS DENTAL, INC.
Entity type:Organization
Organization Name:BURNS DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYSON
Authorized Official - Middle Name:K
Authorized Official - Last Name:AMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDA
Authorized Official - Phone:419-228-5502
Mailing Address - Street 1:459 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-1255
Mailing Address - Country:US
Mailing Address - Phone:419-228-5502
Mailing Address - Fax:419-227-2500
Practice Address - Street 1:459 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-1255
Practice Address - Country:US
Practice Address - Phone:419-228-5502
Practice Address - Fax:419-227-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300219341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2551377Medicaid