Provider Demographics
NPI:1801166129
Name:WILLIAM PETER BUTRICA JR. DDS, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:WILLIAM PETER BUTRICA JR. DDS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:BUTRICA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-528-8400
Mailing Address - Street 1:990 SONOMA AVE
Mailing Address - Street 2:SUITE 22
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4802
Mailing Address - Country:US
Mailing Address - Phone:707-528-8400
Mailing Address - Fax:707-544-4265
Practice Address - Street 1:990 SONOMA AVE
Practice Address - Street 2:SUITE 22
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4802
Practice Address - Country:US
Practice Address - Phone:707-528-8400
Practice Address - Fax:707-544-4265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42036261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental