Provider Demographics
NPI:1992898498
Name:BUTAY, NELSON (DDS)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:BUTAY
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 1:265 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6038
Mailing Address - Country:US
Mailing Address - Phone:909-985-8989
Mailing Address - Fax:909-297-3008
Practice Address - Street 1:265 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6038
Practice Address - Country:US
Practice Address - Phone:909-985-8989
Practice Address - Fax:909-297-3008
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice