Provider Demographics
NPI:1043853765
Name:BUTERA DENTAL SPECIALISTS LLC
Entity type:Organization
Organization Name:BUTERA DENTAL SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTERA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-858-7667
Mailing Address - Street 1:89 ACCESS RD STE 26
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-5232
Mailing Address - Country:US
Mailing Address - Phone:781-255-1919
Mailing Address - Fax:781-255-8992
Practice Address - Street 1:89 ACCESS RD STE 26
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5232
Practice Address - Country:US
Practice Address - Phone:781-255-1919
Practice Address - Fax:781-255-8992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty