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Organization
J MARK BURNETT DDS PS
Active
Organization
J MARK BURNETT DDS PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
J MARK BURNETT DDS (DENTIST)
(253) 565-1181
Entity
Organization
Contact information
Practice address
2603 BRIDGEPORT WAY W, SUITE I, UNIVERSITY PLACE, WA 98466-4724
(253) 565-1181
Mailing address
2603 BRIDGEPORT WAY W, SUITE I, UNIVERSITY PLACE, WA 98466-4724
(253) 565-1181
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4322
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0019571
LABOR & INDUSTRIES
WA
05
—
5005087
—
WA
Enumeration date
09/16/2006
Last updated
08/22/2020
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