Healthcare Provider Details

I. General information

NPI: 1841377256
Provider Name (Legal Business Name): JERRY L BUTLER AND ASSOCIATES DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 BLOWING ROCK RD
BOONE NC
28607
US

IV. Provider business mailing address

851 BLOWING ROCK RD
BOONE NC
28607-4865
US

V. Phone/Fax

Practice location:
  • Phone: 828-264-5858
  • Fax: 828-264-5856
Mailing address:
  • Phone: 828-264-5858
  • Fax: 828-264-5856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3655
License Number StateNC

VIII. Authorized Official

Name: DR. JERRY L BUTLER
Title or Position: PRESIDENT
Credential: DDS
Phone: 828-264-5858