Provider Demographics
NPI:1861886798
Name:BURTON, KIMBALL (DDS)
Entity type:Individual
Prefix:
First Name:KIMBALL
Middle Name:
Last Name:BURTON
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 1:991 SHEPARD LN STE 100
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2973
Mailing Address - Country:US
Mailing Address - Phone:801-737-7437
Mailing Address - Fax:
Practice Address - Street 1:991 SHEPARD LN STE 200
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2974
Practice Address - Country:US
Practice Address - Phone:801-737-7437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-28
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT10364461-99241223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program