Provider Demographics
NPI:1720579865
Name:BUTLER, COLTEN LOUIS (DMD)
Entity type:Individual
Prefix:DR
First Name:COLTEN
Middle Name:LOUIS
Last Name:BUTLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 BOB JESSUP DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-8443
Mailing Address - Country:US
Mailing Address - Phone:435-668-0557
Mailing Address - Fax:
Practice Address - Street 1:4215 W WENDOVER AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1921
Practice Address - Country:US
Practice Address - Phone:336-294-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10846612-9922122300000X
NC12797122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist