Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 7218 | CO |
NPI | 1003928649 |
---|---|
Provider Name | Dr. Daniel Gary Butterman |
First Address | Centennial, CO 80122-2069 |
Second Address | Centennial, CO 80122-2069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 17/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
840801501 | FEDERAL & STATE TAX ID # (01) | CO |