Provider Demographics
NPI:1528172053
Name:BUTTS, THOMAS E (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:BUTTS
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11525 HIGHLAND RD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-2726
Mailing Address - Country:US
Mailing Address - Phone:810-632-0303
Mailing Address - Fax:810-632-7305
Practice Address - Street 1:9880 E GRAND RIVER AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2468
Practice Address - Country:US
Practice Address - Phone:810-227-2626
Practice Address - Fax:810-227-8532
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITB0139171223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI190F37120OtherBCBS OF MI
MIOF37120Medicare ID - Type Unspecified
MIU16590Medicare UPIN
MION78470Medicare ID - Type Unspecified