Provider Demographics
NPI:1003357351
Name:BUTLER, LATOYA SHEMIA (DDS)
Entity type:Individual
Prefix:DR
First Name:LATOYA
Middle Name:SHEMIA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 MICCOSUKEE COMMONS DR APT 1105
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5439
Mailing Address - Country:US
Mailing Address - Phone:901-338-7381
Mailing Address - Fax:
Practice Address - Street 1:604 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:FL
Practice Address - Zip Code:32333-1442
Practice Address - Country:US
Practice Address - Phone:850-539-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-19
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22475122300000X
FLDN224751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist