Provider Demographics
NPI:1013250158
Name:BUTLER-BEARZI, MARTA SUE (RDH)
Entity Type:Individual
Prefix:MS
First Name:MARTA
Middle Name:SUE
Last Name:BUTLER-BEARZI
Suffix:
Gender:F
Credentials:RDH
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 967
Mailing Address - Street 2:
Mailing Address - City:FAIRPLAY
Mailing Address - State:CO
Mailing Address - Zip Code:80440
Mailing Address - Country:US
Mailing Address - Phone:719-836-0967
Mailing Address - Fax:719-836-0967
Practice Address - Street 1:548 FRONT ST
Practice Address - Street 2:SUITE C
Practice Address - City:FAIRPLAY
Practice Address - State:CO
Practice Address - Zip Code:80440
Practice Address - Country:US
Practice Address - Phone:719-836-0967
Practice Address - Fax:719-836-0967
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO200621124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist