Provider Demographics
NPI:1629637764
Name:BUTZIRUS, BEAU DEVEREUX (DMD)
Entity Type:Individual
Prefix:DR
First Name:BEAU
Middle Name:DEVEREUX
Last Name:BUTZIRUS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 MIRALAGO SHORE DR
Mailing Address - Street 2:
Mailing Address - City:COTTLEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63376-3189
Mailing Address - Country:US
Mailing Address - Phone:369-284-0906
Mailing Address - Fax:636-928-4555
Practice Address - Street 1:475 MIRALAGO SHORE DR
Practice Address - Street 2:
Practice Address - City:COTTLEVILLE
Practice Address - State:MO
Practice Address - Zip Code:63376-3189
Practice Address - Country:US
Practice Address - Phone:636-928-4090
Practice Address - Fax:636-928-4555
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019020087122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist