Healthcare Provider Details

I. General information

NPI: 1366237083
Provider Name (Legal Business Name): CRYSTAL ANN BUTLER BS,RDH, OMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2025
Last Update Date: 04/12/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1757 PERIMETER LOOP
WILMINGTON NC
28403-5699
US

IV. Provider business mailing address

1757 PERIMETER LOOP
WILMINGTON NC
28403-5699
US

V. Phone/Fax

Practice location:
  • Phone: 910-635-5048
  • Fax: 910-635-5048
Mailing address:
  • Phone: 910-635-5048
  • Fax: 910-635-5048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number10320
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: