Provider Demographics
NPI:1083739544
Name:BUTT, MOHAMED HANIF (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:HANIF
Last Name:BUTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:HANIF
Other - Last Name:BUTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:341 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-3141
Mailing Address - Country:US
Mailing Address - Phone:617-625-9400
Mailing Address - Fax:617-718-2963
Practice Address - Street 1:341 SUMMER ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-3141
Practice Address - Country:US
Practice Address - Phone:617-625-9400
Practice Address - Fax:617-718-2963
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA180511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics