Provider Demographics
NPI:1467511535
Name:BUTTAR, BALJINDER S (DENTIST)
Entity Type:Individual
Prefix:MR
First Name:BALJINDER
Middle Name:S
Last Name:BUTTAR
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 NE 4TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059
Mailing Address - Country:US
Mailing Address - Phone:425-226-9770
Mailing Address - Fax:425-687-9188
Practice Address - Street 1:4501 NE 4TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059
Practice Address - Country:US
Practice Address - Phone:425-226-9770
Practice Address - Fax:425-687-9188
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00007423122300000X
WA74231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5019690Medicaid