Provider Demographics
NPI:1891908240
Name:BUTLER, JOHN (DDS,SC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:DDS,SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-0200
Mailing Address - Country:US
Mailing Address - Phone:715-356-7330
Mailing Address - Fax:715-358-3388
Practice Address - Street 1:9547 LAKEVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548
Practice Address - Country:US
Practice Address - Phone:715-356-7330
Practice Address - Fax:715-358-3388
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50006111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice