Provider Demographics
NPI:1679046932
Name:BUTTS, KIMBERLY SPENCER (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:SPENCER
Last Name:BUTTS
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:DR
Other - First Name:KIMI
Other - Middle Name:SPENCER
Other - Last Name:BUTTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:23953 MONTROSE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-6367
Mailing Address - Country:US
Mailing Address - Phone:251-455-5181
Mailing Address - Fax:
Practice Address - Street 1:2727 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606
Practice Address - Country:US
Practice Address - Phone:251-473-5705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD0006315-C1122300000X, 1223X0400X
ALC163151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist