Provider Demographics
NPI:1851605000
Name:DR BUTTS ORTHODONTICS PC
Entity Type:Organization
Organization Name:DR BUTTS ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:H
Authorized Official - Last Name:BUTT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-760-3740
Mailing Address - Street 1:341 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-3141
Mailing Address - Country:US
Mailing Address - Phone:617-625-9400
Mailing Address - Fax:
Practice Address - Street 1:1117 ROUTE 28
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-4457
Practice Address - Country:US
Practice Address - Phone:508-760-3740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR BUTTS ORTHODONTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA180511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110011177BMedicaid