Provider Demographics
NPI:1881041671
Name:RICHARD S. BUTLER DDS, PA
Entity Type:Organization
Organization Name:RICHARD S. BUTLER DDS, PA
Other - Org Name:RICHARD S. BUTLER DDS, PA AND ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:LINDA
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:910-617-1211
Mailing Address - Street 1:PO BOX 16702
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28408-6702
Mailing Address - Country:US
Mailing Address - Phone:910-799-9916
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-21
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty