Provider Demographics
NPI:1275788242
Name:BUTLER, SHANNON MCCAMISH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MCCAMISH
Last Name:BUTLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 OAKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3327
Mailing Address - Country:US
Mailing Address - Phone:540-825-0230
Mailing Address - Fax:540-829-0608
Practice Address - Street 1:1051 OAKLAWN DR
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3327
Practice Address - Country:US
Practice Address - Phone:540-825-0230
Practice Address - Fax:540-829-0608
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010085521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice