Provider Demographics
NPI:1437856945
Name:BUTLER, WALTER RYAN (DMD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:RYAN
Last Name:BUTLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 N WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-7210
Mailing Address - Country:US
Mailing Address - Phone:801-782-9544
Mailing Address - Fax:
Practice Address - Street 1:2251 N WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-7210
Practice Address - Country:US
Practice Address - Phone:801-782-9544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13449681-99261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice