Healthcare Provider Details

I. General information

NPI: 1801898093
Provider Name (Legal Business Name): EUGENE JOHN BUTERA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 7TH ST STE 301
GARDEN CITY NY
11530-5747
US

IV. Provider business mailing address

6 VALLEY ST
HUNTINGTON NY
11743-2762
US

V. Phone/Fax

Practice location:
  • Phone: 516-248-1775
  • Fax: 516-248-2313
Mailing address:
  • Phone: 631-421-0462
  • Fax: 631-673-4837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number039589-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: