Provider Demographics
NPI:1063584456
Name:BUTCHER, RICHARD MARK (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MARK
Last Name:BUTCHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11612 FM 2244
Mailing Address - Street 2:SUITE 2-155
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-5409
Mailing Address - Country:US
Mailing Address - Phone:512-263-7896
Mailing Address - Fax:512-263-8005
Practice Address - Street 1:11612 FM 2244
Practice Address - Street 2:SUITE 2-155
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-5409
Practice Address - Country:US
Practice Address - Phone:512-263-7896
Practice Address - Fax:512-263-7896
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX155551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice