Provider Demographics
NPI:1982813168
Name:BUTLER, JENNIFER LEIGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEIGH
Last Name:BUTLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 SAN MARCO LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2378
Mailing Address - Country:US
Mailing Address - Phone:713-569-2561
Mailing Address - Fax:281-204-8104
Practice Address - Street 1:17240 MILL FOREST RD
Practice Address - Street 2:SUITE C
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4370
Practice Address - Country:US
Practice Address - Phone:281-204-8100
Practice Address - Fax:281-204-8104
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21840122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist