Healthcare Provider Details

I. General information

NPI: 1578668042
Provider Name (Legal Business Name): CAESAR C BUTURA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1277 E MISSOURI AVE SUITE 110
PHOENIX AZ
85014-2915
US

IV. Provider business mailing address

1277 E MISSOURI AVE SUITE 110
PHOENIX AZ
85014-2915
US

V. Phone/Fax

Practice location:
  • Phone: 602-248-8745
  • Fax: 602-248-7939
Mailing address:
  • Phone: 602-248-8745
  • Fax: 602-248-7939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5950
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: