Provider Demographics
NPI:1417071952
Name:BUTLER, JAMIE (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
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 1:3334 W PETERSON AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3505
Mailing Address - Country:US
Mailing Address - Phone:773-588-3880
Mailing Address - Fax:
Practice Address - Street 1:3334 W PETERSON AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3505
Practice Address - Country:US
Practice Address - Phone:773-588-3880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist