Provider Demographics
NPI:1427255298
Name:BUTCHER, DONALD DARYOL (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:DARYOL
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 1:115 N LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:MO
Mailing Address - Zip Code:63933-1548
Mailing Address - Country:US
Mailing Address - Phone:573-246-2561
Mailing Address - Fax:573-246-2332
Practice Address - Street 1:115 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:MO
Practice Address - Zip Code:63933-0128
Practice Address - Country:US
Practice Address - Phone:573-246-2561
Practice Address - Fax:573-246-2332
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO140261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice