Provider Demographics
NPI:1790930790
Name:BUTLER, JASON WINFIELD (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:WINFIELD
Last Name:BUTLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CROASDAILE DR
Mailing Address - Street 2:SUITE #5
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2579
Mailing Address - Country:US
Mailing Address - Phone:919-383-7402
Mailing Address - Fax:
Practice Address - Street 1:2900 CROASDAILE DR
Practice Address - Street 2:SUITE #5
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2579
Practice Address - Country:US
Practice Address - Phone:919-383-7402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice