Provider Demographics
NPI:1225887433
Name:BURTON, BENJAMIN (DMD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:BURTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SANDGABLES CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-8712
Mailing Address - Country:US
Mailing Address - Phone:478-319-4727
Mailing Address - Fax:
Practice Address - Street 1:935 MAKAHIKI WAY
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-2896
Practice Address - Country:US
Practice Address - Phone:808-922-4787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program