Provider Demographics
NPI:1376814780
Name:BUTLER, CORYDON BAYLOR JR (DDS)
Entity Type:Individual
Prefix:
First Name:CORYDON
Middle Name:BAYLOR
Last Name:BUTLER
Suffix:JR
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 1:1319 JAMESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3365
Mailing Address - Country:US
Mailing Address - Phone:757-229-7210
Mailing Address - Fax:757-220-4764
Practice Address - Street 1:1319 JAMESTOWN RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3365
Practice Address - Country:US
Practice Address - Phone:757-229-7210
Practice Address - Fax:757-220-4764
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010069611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice