Provider Demographics
NPI:1285049718
Name:BUTLER, MELODY D (DDS)
Entity type:Individual
Prefix:DR
First Name:MELODY
Middle Name:D
Last Name:BUTLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 SILVERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-2956
Mailing Address - Country:US
Mailing Address - Phone:703-495-9992
Mailing Address - Fax:
Practice Address - Street 1:8170 SILVERBROOK RD
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-2956
Practice Address - Country:US
Practice Address - Phone:703-495-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414428122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist