Provider Demographics
NPI:1164738365
Name:BUTLER, GRANT W (DMD)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:W
Last Name:BUTLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2552 F RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1422
Mailing Address - Country:US
Mailing Address - Phone:970-241-1313
Mailing Address - Fax:970-241-5202
Practice Address - Street 1:2552 F RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1422
Practice Address - Country:US
Practice Address - Phone:970-241-1313
Practice Address - Fax:970-241-5202
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL-226-101223G0001X
CO104191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice