Provider Demographics
NPI:1235287012
Name:BURNETT, SCOTT L (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:L
Last Name:BURNETT
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 1:816 DESI LOOP
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-8026
Mailing Address - Country:US
Mailing Address - Phone:406-229-0113
Mailing Address - Fax:
Practice Address - Street 1:1405 N UNION AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-8269
Practice Address - Country:US
Practice Address - Phone:575-622-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18431223G0001X
NMDD39891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice