Provider Demographics
NPI:1023040078
Name:BUTLER, CARROLL RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARROLL
Middle Name:RAY
Last Name:BUTLER
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 1:321 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4297
Mailing Address - Country:US
Mailing Address - Phone:830-257-4900
Mailing Address - Fax:
Practice Address - Street 1:321 W WATER ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4297
Practice Address - Country:US
Practice Address - Phone:830-257-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17648122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74-28336328-89OtherBLUE CROSS BLUE SHIELD