Healthcare Provider Details

I. General information

NPI: 1306121223
Provider Name (Legal Business Name): CHRISTOPHER A BUTLER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1769 NW KINGS BLVD
CORVALLIS OR
97330-1905
US

IV. Provider business mailing address

811 MIMOSA ST S
SALEM OR
97302-5676
US

V. Phone/Fax

Practice location:
  • Phone: 541-757-0755
  • Fax:
Mailing address:
  • Phone: 503-881-3079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD9676
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: