Provider Demographics
NPI:1336210723
Name:BUTLER, THOMAS EDGAR JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDGAR
Last Name:BUTLER
Suffix:JR
Gender:M
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:PO BOX 786
Mailing Address - Street 2:524 N GREENSBORO ST
Mailing Address - City:LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:27298
Mailing Address - Country:US
Mailing Address - Phone:336-622-2951
Mailing Address - Fax:336-622-6155
Practice Address - Street 1:524 N GREENSBORO ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:27298
Practice Address - Country:US
Practice Address - Phone:336-622-2951
Practice Address - Fax:336-622-6155
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6959122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist