Provider Demographics
NPI:1639424245
Name:BUTTON, NICHOLAS RAY (DMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:RAY
Last Name:BUTTON
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 1:10427 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-5110
Mailing Address - Country:US
Mailing Address - Phone:813-302-7126
Mailing Address - Fax:
Practice Address - Street 1:6810 MENAUL BLVD NE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3725
Practice Address - Country:US
Practice Address - Phone:505-872-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2719122300000X
FLDN254651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist