Provider Demographics
NPI:1790847481
Name:BUTLER, ROBERT ERNEST (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ERNEST
Last Name:BUTLER
Suffix:
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 1:337 W LOCKWOOD AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2310
Mailing Address - Country:US
Mailing Address - Phone:314-961-6406
Mailing Address - Fax:314-961-7237
Practice Address - Street 1:337 W LOCKWOOD AVE
Practice Address - Street 2:SUITE D
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2310
Practice Address - Country:US
Practice Address - Phone:314-961-6406
Practice Address - Fax:314-961-7237
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE0141521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice