Healthcare Provider Details

I. General information

NPI: 1427066059
Provider Name (Legal Business Name): DR. MICHAEL R. BUTTERWORTH, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31059 DUPONT BLVD
DAGSBORO DE
19939-4439
US

IV. Provider business mailing address

31059 DUPONT BLVD
DAGSBORO DE
19939-4439
US

V. Phone/Fax

Practice location:
  • Phone: 302-732-9850
  • Fax: 302-732-9839
Mailing address:
  • Phone: 302-732-9850
  • Fax: 302-732-9839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberG1000962
License Number StateDE

VIII. Authorized Official

Name: MRS. AMY R. HALL
Title or Position: OFFICE MANAGER
Credential:
Phone: 302-732-9850