Provider Demographics
NPI:1801898093
Name:BUTERA, EUGENE JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:JOHN
Last Name:BUTERA
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 1:6 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2762
Mailing Address - Country:US
Mailing Address - Phone:631-421-0462
Mailing Address - Fax:631-673-4837
Practice Address - Street 1:233 7TH ST
Practice Address - Street 2:STE 301
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5747
Practice Address - Country:US
Practice Address - Phone:516-248-1775
Practice Address - Fax:516-248-2313
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039589-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice