Provider Demographics
NPI:1861403982
Name:BUTANI, MONA M (DMD)
Entity type:Individual
Prefix:DR
First Name:MONA
Middle Name:M
Last Name:BUTANI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12911 120TH AVE NE STE D50
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3007
Mailing Address - Country:US
Mailing Address - Phone:425-820-0900
Mailing Address - Fax:808-845-0798
Practice Address - Street 1:12911 120TH AVE NE STE D50
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3007
Practice Address - Country:US
Practice Address - Phone:425-820-0900
Practice Address - Fax:808-845-0798
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-2151122300000X
WADE10039122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000243600OtherBCBS
HI0000243600OtherBCBS