Provider Demographics
NPI:1578793451
Name:BUTZ, JAMES T (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:T
Last Name:BUTZ
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 BRIARWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-7225
Mailing Address - Country:US
Mailing Address - Phone:308-382-8772
Mailing Address - Fax:
Practice Address - Street 1:3120 BRIARWOOD BLVD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-7225
Practice Address - Country:US
Practice Address - Phone:308-382-8772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-25
Last Update Date:2009-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE46281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics