Provider Demographics
NPI:1104000801
Name:BUTLER, KLINT RAY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KLINT
Middle Name:RAY
Last Name:BUTLER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 N DIERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4964
Mailing Address - Country:US
Mailing Address - Phone:308-381-8150
Mailing Address - Fax:380-381-1183
Practice Address - Street 1:530 N DIERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4964
Practice Address - Country:US
Practice Address - Phone:308-381-8150
Practice Address - Fax:380-381-1183
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE66841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics