Provider Demographics
NPI:1588626337
Name:BUTLER, ROBIN M (RDH)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:M
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 WEST WORLEY
Mailing Address - Street 2:FAMILY HEALTH CENTER OF BOONE COUNTY
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2037
Mailing Address - Country:US
Mailing Address - Phone:573-214-2314
Mailing Address - Fax:573-442-5208
Practice Address - Street 1:601 BUSINESS LOOP 70 WEST
Practice Address - Street 2:FAMILY DENTAL CENTER, SUITE 216C
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203
Practice Address - Country:US
Practice Address - Phone:573-214-2314
Practice Address - Fax:573-442-5208
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005015578124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1588626337OtherNATIONAL PROVIDER IDENTIF