Provider Demographics
NPI:1407025737
Name:BUTLER, MARK EVERETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EVERETT
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 1:307 S MILWAUKEE AVE
Mailing Address - Street 2:STE. 101
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-5076
Mailing Address - Country:US
Mailing Address - Phone:847-459-3366
Mailing Address - Fax:847-459-3395
Practice Address - Street 1:307 S MILWAUKEE AVE
Practice Address - Street 2:STE. 101
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-5076
Practice Address - Country:US
Practice Address - Phone:847-459-3366
Practice Address - Fax:847-459-3395
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice