Provider Demographics
NPI:1417973108
Name:BUTEAU, BERNARD F (DDS)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:F
Last Name:BUTEAU
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 1:9 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-5021
Mailing Address - Country:US
Mailing Address - Phone:802-773-6966
Mailing Address - Fax:802-773-6924
Practice Address - Street 1:9 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-5021
Practice Address - Country:US
Practice Address - Phone:802-773-6966
Practice Address - Fax:802-773-6924
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00000532122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT850186OtherUNITED CONCORDIA
VT2582Medicaid
VTAB3124219OtherDEA