Healthcare Provider Details

I. General information

NPI: 1265228373
Provider Name (Legal Business Name): TYLER BUTERBAUGH DDS, MBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 ROSE STREET
LEXINGTON KY
40508
US

IV. Provider business mailing address

1122 PERSIMMON DR
LANCASTER PA
17601-7135
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-3368
  • Fax:
Mailing address:
  • Phone: 717-578-7699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11388
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: