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General NPI Number Information
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NPI Number | 1962673970
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Entity Type | Individual
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Provider Name | JOHN RANDAL BUTTRAM DMD
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Gender | Male
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 2335 A STATE AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405
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Country | US
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Telephone | 850-785-5500
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Fax | 850-785-1277
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Provider Business Mailing Address
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Address Line | 2335 A STATE AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405
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Country | US
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Telephone | 850-785-5500
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Fax | 850-785-1277
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN11224
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License Number State | FL
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