Healthcare Provider Details

I. General information

NPI: 1730635954
Provider Name (Legal Business Name): ALEXANDRIA LAUREN BUTLER DMD, MMSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 N BRAND BLVD STE B
GLENDALE CA
91202-3757
US

IV. Provider business mailing address

1138 N BRAND BLVD STE B
GLENDALE CA
91202-3757
US

V. Phone/Fax

Practice location:
  • Phone: 818-552-3636
  • Fax:
Mailing address:
  • Phone: 818-552-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number103892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: