Provider Demographics
NPI:1043484686
Name:DR. CLYDE BUTLER, LLC
Entity Type:Organization
Organization Name:DR. CLYDE BUTLER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-437-2185
Mailing Address - Street 1:43200 US HIGHWAY 72
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:AL
Mailing Address - Zip Code:35772-6702
Mailing Address - Country:US
Mailing Address - Phone:256-437-2158
Mailing Address - Fax:256-437-2230
Practice Address - Street 1:43200 US HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:AL
Practice Address - Zip Code:35772-6702
Practice Address - Country:US
Practice Address - Phone:256-437-2158
Practice Address - Fax:256-437-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty