Provider Demographics
NPI:1114135274
Name:STEVEN C. BUTZEN DMD
Entity Type:Organization
Organization Name:STEVEN C. BUTZEN DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:815-626-1869
Mailing Address - Street 1:110 DIXON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK FALLS
Mailing Address - State:IL
Mailing Address - Zip Code:61071-1700
Mailing Address - Country:US
Mailing Address - Phone:815-626-1869
Mailing Address - Fax:
Practice Address - Street 1:110 DIXON AVE
Practice Address - Street 2:
Practice Address - City:ROCK FALLS
Practice Address - State:IL
Practice Address - Zip Code:61071-1700
Practice Address - Country:US
Practice Address - Phone:815-626-1869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty