Provider Demographics
NPI:1730635954
Name:BUTLER, ALEXANDRIA LAUREN (DMD, MMSC)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRIA
Middle Name:LAUREN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:DMD, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 N BRAND BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3757
Mailing Address - Country:US
Mailing Address - Phone:818-552-3636
Mailing Address - Fax:
Practice Address - Street 1:1138 N BRAND BLVD STE B
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3757
Practice Address - Country:US
Practice Address - Phone:818-552-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1038921223E0200X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics