Provider Demographics
NPI:1609902931
Name:BUTLER, HEIDI D (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:D
Last Name:BUTLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 FINKS HIDEAWAY RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2425
Mailing Address - Country:US
Mailing Address - Phone:318-345-2049
Mailing Address - Fax:
Practice Address - Street 1:1159 FINKS HIDEAWAY RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2425
Practice Address - Country:US
Practice Address - Phone:318-345-2049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA40551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1840556Medicaid