Provider Demographics
NPI:1669253472
Name:BUTLER DENTAL PLLC
Entity type:Organization
Organization Name:BUTLER DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-550-6234
Mailing Address - Street 1:221 STATE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130-1173
Mailing Address - Country:US
Mailing Address - Phone:304-369-1695
Mailing Address - Fax:304-369-1706
Practice Address - Street 1:221 STATE ST STE 102
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130-1173
Practice Address - Country:US
Practice Address - Phone:304-369-1695
Practice Address - Fax:304-369-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty