Healthcare Provider Details

I. General information

NPI: 1801831508
Provider Name (Legal Business Name): PAMELA BUTLER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 SE 192ND AVE SUITE#100
VANCOUVER WA
98683
US

IV. Provider business mailing address

3205 SE 192ND AVE SUITE#100
VANCOUVER WA
98683
US

V. Phone/Fax

Practice location:
  • Phone: 360-891-9283
  • Fax: 360-891-8030
Mailing address:
  • Phone: 360-891-9283
  • Fax: 360-891-8030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD6941
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: