Provider Demographics
NPI:1801806948
Name:BUTLER, STEVEN J (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:BUTLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7845 CARNEGIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-5792
Mailing Address - Country:US
Mailing Address - Phone:260-423-2340
Mailing Address - Fax:260-969-4118
Practice Address - Street 1:7845 CARNEGIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804
Practice Address - Country:US
Practice Address - Phone:260-423-2340
Practice Address - Fax:260-969-4118
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008555204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200029030Medicaid
OH30.019803OtherOHIO STATE LICENSE
IN200029030Medicaid
T69213Medicare UPIN
IN135860Medicare PIN