Provider Demographics
NPI:1588807465
Name:BARTLESVILLE PERIODONTICS AND DENTAL IMPLANTS
Entity Type:Organization
Organization Name:BARTLESVILLE PERIODONTICS AND DENTAL IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:REED
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:918-333-0990
Mailing Address - Street 1:2419 NOWATA PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-4708
Mailing Address - Country:US
Mailing Address - Phone:918-333-0990
Mailing Address - Fax:
Practice Address - Street 1:2419 NOWATA PL
Practice Address - Street 2:SUITE 101
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-4708
Practice Address - Country:US
Practice Address - Phone:918-333-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK51601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty