Provider Demographics
NPI:1598767881
Name:BUTTRUM, JEFFREY D (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:BUTTRUM
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 1:10972 ALLISONVILLE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2637
Mailing Address - Country:US
Mailing Address - Phone:317-845-7878
Mailing Address - Fax:317-570-7193
Practice Address - Street 1:3021 E 98TH ST
Practice Address - Street 2:STE 250
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-2908
Practice Address - Country:US
Practice Address - Phone:317-846-3446
Practice Address - Fax:317-574-5151
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008373122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100226400Medicaid
IN100226400Medicaid
INT90795Medicare UPIN