Provider Demographics
NPI:1306121223
Name:BUTLER, CHRISTOPHER A (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:A
Last Name:BUTLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 MIMOSA ST S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5676
Mailing Address - Country:US
Mailing Address - Phone:503-881-3079
Mailing Address - Fax:
Practice Address - Street 1:1769 NW KINGS BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1905
Practice Address - Country:US
Practice Address - Phone:541-757-0755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist