Basic Information
| Provider Information | |||||||||
| NPI: | 1043298417 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURTON | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5655 HUDSON DR | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | HUDSON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442364451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306553800 | ||||||||
| FaxNumber: | 3306553828 | ||||||||
| Practice Location | |||||||||
| Address1: | 875 8TH ST NE | ||||||||
| Address2: | |||||||||
| City: | MASSILLON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446468503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308328761 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2006 | ||||||||
| LastUpdateDate: | 05/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0904X | 13392 | WV | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085N0904X | 35.080751 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085R0202X | MD423152 | PA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 35.080751 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MTL-2020-012 | GU | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | M-2250 | GU | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 13392 | WV | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 7615108 | 05 | NC | MEDICAID | 0675774 | 05 | OH | MEDICAID | P00152305 | 01 | WV | RAILROAD MC | OTHER | 0117468000 | 05 | WV | MEDICAID | 001948269 | 05 | PA | MEDICAID | P00358707 | 01 | OH | RAILROAD MC | OTHER |