Provider Demographics
NPI:1548257686
Name:BURNETT, ROBERT R (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:BURNETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W. ENT AVE
Mailing Address - Street 2:ATTN: 21 DS/SGGD- DENTAL SQUADRON
Mailing Address - City:PETERSON AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1540
Mailing Address - Country:US
Mailing Address - Phone:719-556-1333
Mailing Address - Fax:719-556-1331
Practice Address - Street 1:110 W. ENT AVE
Practice Address - Street 2:ATTN: 21 DS/SGGD- DENTAL SQUADRON
Practice Address - City:PETERSON AFB
Practice Address - State:CO
Practice Address - Zip Code:80914-1540
Practice Address - Country:US
Practice Address - Phone:719-556-1333
Practice Address - Fax:719-556-1331
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX185961223P0300X
IN85541223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics