Provider Demographics
NPI:1447567003
Name:BURNHAM, RHEANNA (DMD)
Entity type:Individual
Prefix:DR
First Name:RHEANNA
Middle Name:
Last Name:BURNHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3014
Mailing Address - Country:US
Mailing Address - Phone:208-301-3548
Mailing Address - Fax:
Practice Address - Street 1:910 W IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2601
Practice Address - Country:US
Practice Address - Phone:208-667-1154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60178656122300000X
IDD-4332122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist