Alice Matilda Butterworth, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

12007455A Issued in IN

Practice address

803 W Gardner Dr
Marion, IN 46952-1819

Phone

(765) 664-0587

Fax

(765) 664-1407

NPI assigned

Jun 11, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361923200000",
    "number": "1548202153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 W GARDNER DR",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469521819",
            "telephone_number": "765-664-0587",
            "fax_number": "765-664-1407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 W GARDNER DR",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469521819",
            "telephone_number": "765-664-0587",
            "fax_number": "765-664-1407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTTERWORTH",
        "first_name": "ALICE",
        "middle_name": "MATILDA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-11",
        "last_updated": "2013-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IN",
            "license": "12007455A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100143680A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenzie Burton, RBT
• Rhonda Kay Bush, LPN
• Trisha Bush, MSW
• Brandon Lee Bussa, DPT
• Jaden Bussert, RBT
• Renee Lynn Buttler, OTR
• Ivory Bynum, RBT
• Mariah Cade, RBT
• Gina Cale, NCAC II, LCAC, MCAC
• James C Camarata

• Pediatric Dentistry in Marion, IN
• Providers in Marion, IN by specialty
• Pediatric Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.