Healthcare Provider Details

I. General information

NPI: 1407972938
Provider Name (Legal Business Name): RONALD CLAY DE LYRH BUTLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RONALD CLAY BUTLER DDS

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 N MESA SUITE 1 SOUTH
EL PASO TX
79912
US

IV. Provider business mailing address

7211 N MESA SUITE 1 SOUTH
EL PASO TX
79912
US

V. Phone/Fax

Practice location:
  • Phone: 915-581-7800
  • Fax: 915-587-8995
Mailing address:
  • Phone: 915-581-7800
  • Fax: 915-587-8995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number12943
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: