Provider Demographics
NPI:1992739544
Name:BUTLER, ALLEN WARD (DDS)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:WARD
Last Name:BUTLER
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 1:1048-12TH STREET
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586
Mailing Address - Country:US
Mailing Address - Phone:812-547-8670
Mailing Address - Fax:
Practice Address - Street 1:1048-12TH STREET
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586
Practice Address - Country:US
Practice Address - Phone:812-547-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007221A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice