Beau Devereux Butzirus, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

2019020087 Issued in MO

Practice address

475 Miralago Shore Dr
Cottleville, MO 63376-3189

Phone

(636) 928-4090

Fax

(636) 928-4555

NPI assigned

Jun 12, 2019

Last updated

Mar 18, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tanner Brown DMD LLC

  dba Good Company Dental Cottleville

  • Dental Clinic/Center
  • Saint Peters, MO
  • NPI 1225618796
  NPD
• Alex Sharifian DDS Blue Springs Dentistry PC

  dba Blue Springs Dentistry

  • General Practice Dentistry
  • Blue Springs, MO
  • NPI 1083027411
  NPD (past)
• Bryan Watanabe DDS, White Oaks Dental Group, PC

  • Dentist
  • Blue Springs, MO
  • NPI 1457872962
  NPD (past)
• DRS.Kraner and Kraner , LLC

  • General Practice Dentistry
  • Wentzville, MO
  • NPI 1134393747
  NPD (past)
• Kraner Family Dentistry

  • General Practice Dentistry
  • Wentzville, MO
  • NPI 1023161627
  NPD (past)
• Tanner Brown DMD LLC

  • Dental Clinic/Center
  • Saint Peters, MO
  • NPI 1649049248
  NPD (past)

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

{
    "created_epoch": "1560297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1629637764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 MIRALAGO SHORE DR",
            "city": "COTTLEVILLE",
            "state": "MO",
            "postal_code": "633763189",
            "telephone_number": "369-284-0906",
            "fax_number": "636-928-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 MIRALAGO SHORE DR",
            "city": "COTTLEVILLE",
            "state": "MO",
            "postal_code": "633763189",
            "telephone_number": "636-928-4090",
            "fax_number": "636-928-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTZIRUS",
        "first_name": "BEAU",
        "middle_name": "DEVEREUX",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-12",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2019020087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ask Dr H Healthy Solutions LLC
• Matthew J Bauer, DMD MS
• Emily Elizabeth Blau, DC
• Bunge Spine & Performance, LLC
• William Bunge, D.C.
• Collective Therapy (Collective Therapy, LLC)
• Austin Michael Conrod, DC, MS
• Taylor K Eudy, M.ED., LPC
• Shari M. Flanagan, D.C.
• Gateway Little Smiles, LLC (Gateway Little Smiles)

• Dentist in Cottleville, MO
• Providers in Cottleville, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.