Provider Demographics
NPI:1386973931
Name:BURTON ADVANCE DENTAL, P.C.
Entity type:Organization
Organization Name:BURTON ADVANCE DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:NIVISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-742-6600
Mailing Address - Street 1:5492 LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-2235
Mailing Address - Country:US
Mailing Address - Phone:810-742-6600
Mailing Address - Fax:810-742-5075
Practice Address - Street 1:5492 LAPEER RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-2235
Practice Address - Country:US
Practice Address - Phone:810-742-6600
Practice Address - Fax:810-742-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI145881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty