Active NPI
Raheem Butt, DMD
- General Practice Dentistry
- Carbondale, IL
National Provider Identifier
1639858442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019.034336
- Practice address
- 1001 N Beadle Dr
Carbondale, IL 62901-1150 - Phone
- (618) 457-2123
- NPI assigned
- Jul 18, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019.034336 | IL | Primary |
Addresses
Primary practice location
1001 N Beadle Dr
Carbondale, IL 62901-1150
Mailing address
330 Meadowood LN
Carbondale, IL 62901-1962
Phone (618) 303-2970
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.034336 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696809600000",
"number": "1639858442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 MEADOWOOD LN",
"city": "CARBONDALE",
"state": "IL",
"postal_code": "629011962",
"telephone_number": "618-303-2970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 N BEADLE DR",
"city": "CARBONDALE",
"state": "IL",
"postal_code": "629011150",
"telephone_number": "618-457-2123"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUTT",
"first_name": "RAHEEM",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-07-18",
"last_updated": "2023-10-09",
"certification_date": "2023-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019.034336",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carbondale, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.