Healthcare Provider Details

I. General information

NPI: 1437162971
Provider Name (Legal Business Name): FRED BUETTNER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 SEQUOIA AVE
LINDSAY CA
93247-1422
US

IV. Provider business mailing address

709 SEQUOIA AVE
LINDSAY CA
93247-1422
US

V. Phone/Fax

Practice location:
  • Phone: 559-562-5171
  • Fax: 559-562-4891
Mailing address:
  • Phone: 559-562-5171
  • Fax: 559-562-4891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number40059
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: