Provider Demographics
NPI:1124035548
Name:BUTLER, ELMER GARRY
Entity Type:Individual
Prefix:DR
First Name:ELMER
Middle Name:GARRY
Last Name:BUTLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ELMER
Other - Middle Name:
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5786 STAGE RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-4518
Mailing Address - Country:US
Mailing Address - Phone:901-388-4811
Mailing Address - Fax:901-388-4811
Practice Address - Street 1:5786 STAGE RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-4518
Practice Address - Country:US
Practice Address - Phone:901-388-4811
Practice Address - Fax:901-388-4811
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice