Robert Ernest Butler, DDS

Individual provider Active NPI General Practice Dentistry · Webster Groves, MO

NPI 1790847481 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1790847481
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
DE014152 (MO)
Practice address
337 W Lockwood Ave
Suite D
Webster Groves, MO 63119-2310
Phone
(314) 961-6406
Fax
(314) 961-7237
NPI assigned
Dec 15, 2006
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20150724010340 MO Order and Referring Only - Oral Surgery
Practitioner - Oral Surgery
1254644859

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
DE014152MOMDGeneral Practice Dentistry

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DE014152 MO Yes

Addresses

Primary practice location

337 W Lockwood Ave
Suite D
Webster Groves, MO 63119-2310

Mailing address

337 W Lockwood Ave
Suite D
Webster Groves, MO 63119-2310
Phone (314) 961-6406

Other providers in Webster Groves, MO

All providers in Webster Groves, MO · General Practice Dentistry in Missouri

Sources for this page

Verify at the official NPI Registry.