Provider Demographics
NPI:1841377256
Name:JERRY L BUTLER AND ASSOCIATES DDS PLLC
Entity type:Organization
Organization Name:JERRY L BUTLER AND ASSOCIATES DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-264-5858
Mailing Address - Street 1:851 BLOWING ROCK RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4865
Mailing Address - Country:US
Mailing Address - Phone:828-264-5858
Mailing Address - Fax:828-264-5856
Practice Address - Street 1:851 BLOWING ROCK RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607
Practice Address - Country:US
Practice Address - Phone:828-264-5858
Practice Address - Fax:828-264-5856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3655122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty