Healthcare Provider Details

I. General information

NPI: 1295873214
Provider Name (Legal Business Name): HEIDI MARIE BUTTS D.M.D., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8760 BIG BEND BLVD
SAINT LOUIS MO
63119-3730
US

IV. Provider business mailing address

8760 BIG BEND BLVD
SAINT LOUIS MO
63119-3730
US

V. Phone/Fax

Practice location:
  • Phone: 314-961-7565
  • Fax:
Mailing address:
  • Phone: 314-961-7565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number015967
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: