Provider Demographics
NPI:1285637538
Name:BOBBY L. BUTLER, DDS PLLC
Entity Type:Organization
Organization Name:BOBBY L. BUTLER, DDS PLLC
Other - Org Name:ADVANCED PERIODONTICS, MICROSURGERY & IMPLANTOLOGY OF SEATTLE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-223-1501
Mailing Address - Street 1:509 OLIVE WAY
Mailing Address - Street 2:STE 1524
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1749
Mailing Address - Country:US
Mailing Address - Phone:206-223-1501
Mailing Address - Fax:206-223-1554
Practice Address - Street 1:509 OLIVE WAY
Practice Address - Street 2:STE 1524
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1749
Practice Address - Country:US
Practice Address - Phone:206-223-1501
Practice Address - Fax:206-223-1554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000069931223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty