Provider Demographics
NPI:1770577686
Name:BURNETT, RITA M (DDS)
Entity type:Individual
Prefix:DR
First Name:RITA
Middle Name:M
Last Name:BURNETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:155 S 18TH ST
Mailing Address - Street 2:212
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-5642
Mailing Address - Country:US
Mailing Address - Phone:913-371-8499
Mailing Address - Fax:913-371-0568
Practice Address - Street 1:155 S 18TH ST
Practice Address - Street 2:212
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-5642
Practice Address - Country:US
Practice Address - Phone:913-371-8499
Practice Address - Fax:913-371-0568
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS59571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4054837102Medicaid
KS102886Medicaid
MO10935015OtherBCBS
KS27708OtherBCBS
KS102644OtherCIGNA
KS5957OtherDELTA