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General NPI Number Information
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NPI Number | 1710187000
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Entity Type | Organization
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Legal Business Name | BUTLER FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 07/24/2007
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Provider Practice Location Address
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Address Line | 819 MAIN ST
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City | TELL CITY
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State | IN
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Zip | 47586-2105
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Country | US
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Telephone | 812-548-4444
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Fax | 812-548-4411
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Provider Business Mailing Address
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Address Line | 819 MAIN ST
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City | TELL CITY
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State | IN
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Zip | 47586-2105
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Country | US
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Telephone | 812-548-4444
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Fax | 812-548-4411
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW ALLEN BUTLER
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Credential | DDS
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Telephone | 812-548-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12010730A
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License Number State | IN
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