Provider Demographics
NPI:1508165168
Name:BUTLER, ALYSSA LYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:LYN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:ALYSSA
Other - Middle Name:LYN
Other - Last Name:VANGILDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 CORNHUSKER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-7911
Mailing Address - Country:US
Mailing Address - Phone:402-293-1234
Mailing Address - Fax:
Practice Address - Street 1:505 CORNHUSKER RD STE 102
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-7911
Practice Address - Country:US
Practice Address - Phone:402-293-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011014462122300000X
NE7186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist