Provider Demographics
NPI:1467587477
Name:JENNIFER EDWARDS BUTLER, DMD, PA
Entity Type:Organization
Organization Name:JENNIFER EDWARDS BUTLER, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:EDWARDS
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-488-2526
Mailing Address - Street 1:2608 MAIN ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-3760
Mailing Address - Country:US
Mailing Address - Phone:832-488-2526
Mailing Address - Fax:843-488-2535
Practice Address - Street 1:2608 MAIN ST UNIT B
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3760
Practice Address - Country:US
Practice Address - Phone:832-488-2526
Practice Address - Fax:843-488-2535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty