Provider Demographics
NPI:1528194388
Name:BUTRYMOWICZ, BOGDAN ZYGMUND (DDS)
Entity Type:Individual
Prefix:DR
First Name:BOGDAN
Middle Name:ZYGMUND
Last Name:BUTRYMOWICZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1544
Mailing Address - Country:US
Mailing Address - Phone:914-963-3777
Mailing Address - Fax:914-423-6215
Practice Address - Street 1:717 N BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1544
Practice Address - Country:US
Practice Address - Phone:914-963-3777
Practice Address - Fax:914-423-6215
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist