Provider Demographics
NPI:1194865162
Name:BUTSON, TIMOTHY J (DMD, MSD, PLLC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:BUTSON
Suffix:
Gender:M
Credentials:DMD, MSD, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13231 SE 312TH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-3235
Mailing Address - Country:US
Mailing Address - Phone:253-351-6806
Mailing Address - Fax:
Practice Address - Street 1:720 OLIVE WAY
Practice Address - Street 2:SUITE 822
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1878
Practice Address - Country:US
Practice Address - Phone:206-624-7706
Practice Address - Fax:206-467-7724
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA65951223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics