Individual
AMISH BUTALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
110 BERGEN ST, NEWARK, NJ 07103-2495
(973) 972-4242
Mailing address
54 LYLE PL, EDISON, NJ 08820-4433
(908) 705-0463
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI0268900
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/23/2016
Last updated
04/15/2025
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