Provider Demographics
NPI:1477588804
Name:BUTCHER, ANDY ROY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:ROY
Last Name:BUTCHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 OTIS BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-2606
Mailing Address - Country:US
Mailing Address - Phone:864-583-2737
Mailing Address - Fax:864-576-9678
Practice Address - Street 1:552 OTIS BLVD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2606
Practice Address - Country:US
Practice Address - Phone:864-583-2737
Practice Address - Fax:864-576-9678
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice