MEDICARE: BOBBY L. BUTLER, DDS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	DE00006993	WA

General Provider Information

NPI Number	:	1285637538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOBBY L. BUTLER, DDS PLLC

Provider Business Mailing Address
First Line	:	509 OLIVE WAY
Second Line	:	STE 1524
City	:	SEATTLE
State	:	WA
Zip	:	98101-1749
Country	:	US
Telephone Number	:	206-223-1501
Fax Number	:	206-223-1554

Provider Business Practice Location Address
First Line	:	509 OLIVE WAY
Second Line	:	STE 1524
City	:	SEATTLE
State	:	WA
Zip	:	98101-1749
Country	:	US
Telephone Number	:	206-223-1501
Fax Number	:	206-223-1554

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BOBBY LYNN BUTLER
Credential	:	DDS
Telephone Number	:	206-223-1501

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/22/2020

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