Healthcare Provider Details

I. General information

NPI: 1194865162
Provider Name (Legal Business Name): TIMOTHY J. BUTSON DMD, MSD, PLLC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 OLIVE WAY SUITE 822
SEATTLE WA
98101-1878
US

IV. Provider business mailing address

13231 SE 312TH ST
AUBURN WA
98092-3235
US

V. Phone/Fax

Practice location:
  • Phone: 206-624-7706
  • Fax: 206-467-7724
Mailing address:
  • Phone: 253-351-6806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number6595
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: