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General NPI Number Information
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NPI Number | 1588807465
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Entity Type | Organization
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Legal Business Name | BARTLESVILLE PERIODONTICS AND DENTAL IMPLANTS
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 04/08/2009
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Provider Practice Location Address
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Address Line | 2419 NOWATA PL SUITE 101
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City | BARTLESVILLE
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State | OK
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Zip | 74006-4708
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Country | US
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Telephone | 918-333-0990
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Fax |
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Provider Business Mailing Address
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Address Line | 2419 NOWATA PL SUITE 101
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City | BARTLESVILLE
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State | OK
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Zip | 74006-4708
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Country | US
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Telephone | 918-333-0990
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Fax |
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DR. JIMMIE REED BUTLER
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Credential | DDS, MS
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Telephone | 918-333-0990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 5160
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License Number State | OK
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