Provider Demographics
NPI:1073603726
Name:BUTTERMORE, JAMES ERVIN SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ERVIN
Last Name:BUTTERMORE
Suffix:SR
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 1:305 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-3737
Mailing Address - Country:US
Mailing Address - Phone:402-494-4924
Mailing Address - Fax:402-494-0928
Practice Address - Street 1:305 W 39TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3737
Practice Address - Country:US
Practice Address - Phone:402-494-4924
Practice Address - Fax:402-494-0928
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE53291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice