Provider Demographics
NPI:1861185910
Name:BUTLER, JARED HUNTER (DDS)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:HUNTER
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 1:108 ROCKCREST DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-2324
Mailing Address - Country:US
Mailing Address - Phone:304-550-6234
Mailing Address - Fax:
Practice Address - Street 1:221 STATE ST STE 102
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130-1173
Practice Address - Country:US
Practice Address - Phone:304-550-6234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV46361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty