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General NPI Number Information
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NPI Number | 1669913182
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Entity Type | Organization
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Legal Business Name | ALICE M. BUTTERWORTH, D.D.S.
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Dates
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Enumeration Date | 03/16/2017
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Last Update Date | 03/16/2017
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Provider Practice Location Address
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Address Line | 803 W GARDNER DR
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City | MARION
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State | IN
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Zip | 46952-1819
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Country | US
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Telephone | 765-664-0587
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Fax | 765-664-1407
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Provider Business Mailing Address
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Address Line | 803 W GARDNER DR
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City | MARION
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State | IN
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Zip | 46952-1819
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Country | US
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Telephone | 765-664-0587
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Fax | 765-664-1407
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | WENDY MARLEY
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Credential |
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Telephone | 765-664-0587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12007455
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License Number State | IN
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