Provider Demographics
NPI:1437746989
Name:GREGORY BUTLER DENTAL GROUP LLC
Entity Type:Organization
Organization Name:GREGORY BUTLER DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:TERLOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-868-2221
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:IN
Mailing Address - Zip Code:46721-0017
Mailing Address - Country:US
Mailing Address - Phone:260-868-2221
Mailing Address - Fax:260-868-2485
Practice Address - Street 1:106 E GREEN ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:IN
Practice Address - Zip Code:46721-1126
Practice Address - Country:US
Practice Address - Phone:260-868-2221
Practice Address - Fax:260-868-2485
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREGORY BUTLER DENTAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty