Provider Demographics
NPI:1114025319
Name:BUTLER, JAMES ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
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 1:324 29TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1428
Mailing Address - Country:US
Mailing Address - Phone:304-523-2790
Mailing Address - Fax:304-523-2780
Practice Address - Street 1:324 29TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1428
Practice Address - Country:US
Practice Address - Phone:304-523-2790
Practice Address - Fax:304-523-2780
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2450122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000155464OtherBC/BS PROVIDER NUMBER
WV0136895000Medicaid
WV155464OtherUNITED CONCORDIA PROVIDER