Healthcare Provider Details

I. General information

NPI: 1174928709
Provider Name (Legal Business Name): DAVID F BUTLER, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 CRAGMONT ST
MADISON IN
47250-3003
US

IV. Provider business mailing address

505 CRAGMONT ST
MADISON IN
47250-3003
US

V. Phone/Fax

Practice location:
  • Phone: 812-265-6225
  • Fax: 812-265-5933
Mailing address:
  • Phone: 812-265-6225
  • Fax: 812-265-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12008372
License Number StateIN

VIII. Authorized Official

Name: DR. DAVID F BUTLER
Title or Position: OWNER
Credential: DDS
Phone: 812-265-6225