Provider Demographics
NPI:1700832698
Name:BUTLER, RICHARD STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:STEPHEN
Last Name:BUTLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4837 CAROLINA BEACH RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2368
Mailing Address - Country:US
Mailing Address - Phone:910-799-9916
Mailing Address - Fax:910-399-1702
Practice Address - Street 1:4837 CAROLINA BEACH RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2368
Practice Address - Country:US
Practice Address - Phone:910-799-9916
Practice Address - Fax:910-399-1702
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1264WOtherBLUECROSS BLUESHIELD
NC891264WMedicaid
NC891264WMedicaid
U80268Medicare UPIN