Provider Demographics
NPI:1679977656
Name:M FOREST BUTLER DDS MS PC
Entity type:Organization
Organization Name:M FOREST BUTLER DDS MS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:FOREST
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-921-3555
Mailing Address - Street 1:320 KILLIAN HILL RD NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3809
Mailing Address - Country:US
Mailing Address - Phone:770-921-3555
Mailing Address - Fax:770-564-2244
Practice Address - Street 1:320 KILLIAN HILL RD NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3809
Practice Address - Country:US
Practice Address - Phone:770-921-3555
Practice Address - Fax:770-564-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA79991223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty