Individual
DR. STEVEN J BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7845 CARNEGIE BLVD, FORT WAYNE, IN 46804
(260) 423-2340
(260) 969-4118
Mailing address
7845 CARNEGIE BLVD, FORT WAYNE, IN 46804-5792
(260) 423-2340
(260) 969-4118
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
12008555
IN
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
12008555
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200029030
—
IN
01
—
30.019803
OHIO STATE LICENSE
OH
Enumeration date
08/09/2006
Last updated
07/09/2020
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