Provider Demographics
NPI:1538217302
Name:BUTTROSS, MYLENE (DDS)
Entity type:Individual
Prefix:
First Name:MYLENE
Middle Name:
Last Name:BUTTROSS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 RESEARCH FOREST DRIVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1509
Mailing Address - Country:US
Mailing Address - Phone:832-585-0330
Mailing Address - Fax:832-585-0337
Practice Address - Street 1:7901 RESEARCH FOREST DRIVE
Practice Address - Street 2:SUITE 800
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-1509
Practice Address - Country:US
Practice Address - Phone:832-585-0330
Practice Address - Fax:832-585-0337
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice