Provider Demographics
NPI:1174680219
Name:BUTLER, BARRY LEON (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:LEON
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 1:3613 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-5003
Mailing Address - Country:US
Mailing Address - Phone:972-475-3995
Mailing Address - Fax:972-463-4298
Practice Address - Street 1:3613 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-5003
Practice Address - Country:US
Practice Address - Phone:972-475-3995
Practice Address - Fax:972-463-4298
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice