Provider Demographics
NPI:1134218514
Name:BUTLER, BENJAMIN CHASE (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:CHASE
Last Name:BUTLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 E FOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-4110
Mailing Address - Country:US
Mailing Address - Phone:719-635-0603
Mailing Address - Fax:
Practice Address - Street 1:6800 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3200
Practice Address - Country:US
Practice Address - Phone:303-727-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8991122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist