=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174928709
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID F BUTLER, DDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2014
-----------------------------------------------------
Last Update Date | 10/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505 CRAGMONT ST
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47250-3003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-265-6225
-----------------------------------------------------
Fax | 812-265-5933
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 505 CRAGMONT ST
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47250-3003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-265-6225
-----------------------------------------------------
Fax | 812-265-5933
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DAVID F BUTLER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 812-265-6225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 12008372
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------