Provider Demographics
NPI:1255442877
Name:BURNHAM, JOHN WESTROM (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WESTROM
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 1:101 EAST 5TH ST
Mailing Address - Street 2:SUITE #1702
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101
Mailing Address - Country:US
Mailing Address - Phone:651-224-8382
Mailing Address - Fax:
Practice Address - Street 1:101 EAST 5TH ST
Practice Address - Street 2:SUITE 1702
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101
Practice Address - Country:US
Practice Address - Phone:651-224-8382
Practice Address - Fax:651-224-6720
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN 8068122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U45615Medicare UPIN
MN483017200Medicare ID - Type Unspecified