Provider Demographics
NPI:1760591598
Name:BUTTKE, THOMAS M (PHD, DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:BUTTKE
Suffix:
Gender:M
Credentials:PHD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 S CROATAN HWY
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959-8809
Mailing Address - Country:US
Mailing Address - Phone:252-480-6646
Mailing Address - Fax:252-480-0249
Practice Address - Street 1:2522 S CROATAN HWY
Practice Address - Street 2:SUITE 1-C
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-8809
Practice Address - Country:US
Practice Address - Phone:252-480-6646
Practice Address - Fax:252-480-0249
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69601223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics