Healthcare Provider Details

I. General information

NPI: 1528172053
Provider Name (Legal Business Name): THOMAS E BUTTS D.D.S.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9880 E GRAND RIVER AVE SUITE 150
BRIGHTON MI
48116-2468
US

IV. Provider business mailing address

11525 HIGHLAND RD SUITE 23
HARTLAND MI
48353-2726
US

V. Phone/Fax

Practice location:
  • Phone: 810-227-2626
  • Fax: 810-227-8532
Mailing address:
  • Phone: 810-632-0303
  • Fax: 810-632-7305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberTB013917
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberTB013917
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: