Individual
SIDRA BUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
14631 CHARTER WALK CT, MIDLOTHIAN, VA 23114-4694
(804) 874-1598
Mailing address
14631 CHARTER WALK CT, MIDLOTHIAN, VA 23114-4694
(804) 874-1598
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5539
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1855391
—
LA
05
—
1940801
—
LA
Enumeration date
01/25/2007
Last updated
03/25/2009
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