Basic Information
| Provider Information | |||||||||
| NPI: | 1912228255 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURTON | ||||||||
| FirstName: | KATHARINE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 BENEFIT ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029042762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015213822 | ||||||||
| FaxNumber: | 4015211020 | ||||||||
| Practice Location | |||||||||
| Address1: | 612 CENTRE ST | ||||||||
| Address2: | |||||||||
| City: | JAMAICA PLAIN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021302552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175244400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2010 | ||||||||
| LastUpdateDate: | 01/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 1684 | RI | Y | Dental Providers | Dentist | General Practice |
No ID Information.