Provider Demographics
NPI:1730181181
Name:BURTON, BONNIE L (DDS)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:L
Last Name:BURTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 NW HOMESTEAD DR
Mailing Address - Street 2:SUITE I
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5288
Mailing Address - Country:US
Mailing Address - Phone:580-536-2662
Mailing Address - Fax:580-536-2226
Practice Address - Street 1:1320 NW HOMESTEAD DR
Practice Address - Street 2:SUITE I
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5288
Practice Address - Country:US
Practice Address - Phone:580-536-2662
Practice Address - Fax:580-536-2226
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2014-10-07
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
OK40981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice