Provider Demographics
NPI:1952447237
Name:BUETTNER, JOHN A (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:BUETTNER
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 1:4790 WOODMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3065
Mailing Address - Country:US
Mailing Address - Phone:334-279-0760
Mailing Address - Fax:334-215-1153
Practice Address - Street 1:4790 WOODMERE BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3065
Practice Address - Country:US
Practice Address - Phone:334-279-0760
Practice Address - Fax:334-215-1153
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL40761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51501071OtherBCBS PROVIDER ID
AL801707OtherUNITED CONCORDIA