# J MARK BURNETT DDS PS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679679674
- **Authorized official:** J MARK BURNETT DDS (DENTIST)
- **Authorized official phone:** (253) 565-1181

## Contact information

- **Practice address:** 2603 BRIDGEPORT WAY W, SUITE I, UNIVERSITY PLACE, WA 98466-4724
- **Practice address phone:** (253) 565-1181
- **Mailing address:** 2603 BRIDGEPORT WAY W, SUITE I, UNIVERSITY PLACE, WA 98466-4724
- **Mailing address phone:** (253) 565-1181

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4322 | WA | Yes |

## Other

- **Enumeration date:** 09/16/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0019571 | LABOR & INDUSTRIES | WA |
| 05 | — | 5005087 | — | WA |