Active NPI
Steven J Butler, DDS
- Oral & Maxillofacial Surgery (D.M.D.)
- Fort Wayne, IN
National Provider Identifier
1801806948
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral & Maxillofacial Surgery (D.M.D.)
- License
- 12008555
- Practice address
- 7845 Carnegie Blvd
Fort Wayne, IN 46804 - Phone
- (260) 423-2340
- Fax
- (260) 969-4118
- NPI assigned
- Aug 9, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral & Maxillofacial Surgery (D.M.D.) | 204E00000X | 12008555 | IN | Primary |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 12008555 | IN |
Addresses
Primary practice location
7845 Carnegie Blvd
Fort Wayne, IN 46804
Mailing address
7845 Carnegie Blvd
Fort Wayne, IN 46804-5792
Phone (260) 423-2340
Other practice location 1
4606 D East State Blvd
Fort Wayne, IN 46815-6963
Phone (260) 423-2340
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200029030 | Medicaid | IN | |
| 30.019803 | Other | OH | OHIO STATE LICENSE |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594252800000",
"number": "1801806948",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7845 CARNEGIE BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468045792",
"telephone_number": "260-423-2340",
"fax_number": "260-969-4118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7845 CARNEGIE BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "46804",
"telephone_number": "260-423-2340",
"fax_number": "260-969-4118"
}
],
"practiceLocations": [
{
"address_1": "4606 D East State Blvd",
"address_purpose": "LOCATION",
"city": "Fort Wayne",
"state": "IN",
"postal_code": "468156963",
"country_code": "US",
"telephone_number": "260-423-2340",
"fax_number": "260-422-5342",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BUTLER",
"first_name": "STEVEN",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2020-07-09",
"certification_date": "2020-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "204E00000X",
"taxonomy_group": "",
"desc": "Oral & Maxillofacial Surgery",
"state": "IN",
"license": "12008555",
"primary": true
},
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "IN",
"license": "12008555",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200029030",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OHIO STATE LICENSE",
"identifier": "30.019803",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.