Provider Demographics
NPI:1144568965
Name:JEFFREY S. BUTTS DDS PC
Entity Type:Organization
Organization Name:JEFFREY S. BUTTS DDS PC
Other - Org Name:CAMP CREEK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:BUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-344-2323
Mailing Address - Street 1:3650 MARKETPLACE BLVD
Mailing Address - Street 2:SUITE 920
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5741
Mailing Address - Country:US
Mailing Address - Phone:404-344-2323
Mailing Address - Fax:404-344-8123
Practice Address - Street 1:3650 MARKETPLACE BLVD
Practice Address - Street 2:SUITE 920
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5741
Practice Address - Country:US
Practice Address - Phone:404-344-2323
Practice Address - Fax:404-344-8123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD0000X
GADN014167261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental