Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 9258 | CO |
N | 204E00000X | Oral & Maxillofacial Surgeon | DR-45157 | CO |
NPI | 1538228580 |
---|---|
Provider Name | Dr. Michael Allan Burnham |
First Address | Thornton, CO 80241-2427 |
Second Address | Thornton, CO 80241-2427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 06/03/2013 |