Provider Demographics
NPI:1598874356
Name:THOMAS M. BUTTKE, PH.D., D.D.S., P.A.
Entity Type:Organization
Organization Name:THOMAS M. BUTTKE, PH.D., D.D.S., P.A.
Other - Org Name:COASTAL ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUTTKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, DDS
Authorized Official - Phone:252-480-6646
Mailing Address - Street 1:2522 S CROATAN HWY
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959-8809
Mailing Address - Country:US
Mailing Address - Phone:252-480-6646
Mailing Address - Fax:252-480-0249
Practice Address - Street 1:2522 S CROATAN HWY
Practice Address - Street 2:SUITE 1-C
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-8809
Practice Address - Country:US
Practice Address - Phone:252-480-6646
Practice Address - Fax:252-480-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69601223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty