Provider Demographics
NPI:1538228580
Name:BURNHAM, MICHAEL ALLAN (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALLAN
Last Name:BURNHAM
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 E 128TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-2427
Mailing Address - Country:US
Mailing Address - Phone:303-451-6767
Mailing Address - Fax:303-451-5908
Practice Address - Street 1:300 E 128TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-2427
Practice Address - Country:US
Practice Address - Phone:303-451-6767
Practice Address - Fax:303-451-5908
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92581223S0112X
CODR-45157204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery