Provider Demographics
NPI:1679094775
Name:BUTLER DENTAL GROUP, LLC
Entity Type:Organization
Organization Name:BUTLER DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:260-493-2432
Mailing Address - Street 1:1210 SAINT ANDREWS PL
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-9469
Mailing Address - Country:US
Mailing Address - Phone:260-414-2536
Mailing Address - Fax:
Practice Address - Street 1:106 E GREEN ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:IN
Practice Address - Zip Code:46721-1126
Practice Address - Country:US
Practice Address - Phone:260-868-2221
Practice Address - Fax:260-868-2459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty