Provider Demographics
NPI:1699348334
Name:BUTLER, ANDREA M (RDH)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 N SCULLY DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4037
Mailing Address - Country:US
Mailing Address - Phone:815-355-5640
Mailing Address - Fax:
Practice Address - Street 1:1314 N SCULLY DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4037
Practice Address - Country:US
Practice Address - Phone:815-355-5640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020.016948124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist