MEDICARE: DR. EUGENE JOHN BUTERA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	039589-1	NY

General Provider Information

NPI Number	:	1801898093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EUGENE JOHN BUTERA D.D.S.

Provider Business Mailing Address
First Line	:	6 VALLEY ST
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-2762
Country	:	US
Telephone Number	:	631-421-0462
Fax Number	:	631-673-4837

Provider Business Practice Location Address
First Line	:	233 7TH ST
Second Line	:	STE 301
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-5747
Country	:	US
Telephone Number	:	516-248-1775
Fax Number	:	516-248-2313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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