Provider Demographics
NPI:1215051685
Name:BURNHAM, RICHARD S (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
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 1:5022 HIGHWAY 90A
Mailing Address - Street 2:STE C
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-2074
Mailing Address - Country:US
Mailing Address - Phone:281-340-1333
Mailing Address - Fax:281-340-1338
Practice Address - Street 1:5022 HIGHWAY 90A
Practice Address - Street 2:STE C
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-2074
Practice Address - Country:US
Practice Address - Phone:281-340-1333
Practice Address - Fax:281-340-1338
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice