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General NPI Number Information
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NPI Number | 1801166129
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Entity Type | Organization
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Legal Business Name | WILLIAM PETER BUTRICA JR. DDS, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/03/2012
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 990 SONOMA AVE SUITE 22
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City | SANTA ROSA
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State | CA
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Zip | 95404-4802
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Country | US
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Telephone | 707-528-8400
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Fax | 707-544-4265
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Provider Business Mailing Address
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Address Line | 990 SONOMA AVE SUITE 22
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City | SANTA ROSA
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State | CA
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Zip | 95404-4802
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Country | US
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Telephone | 707-528-8400
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Fax | 707-544-4265
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM PETER BUTRICA JR.
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Credential | D.D.S.
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Telephone | 707-528-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 42036
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License Number State | CA
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