Dr. Clinton Bissell Butler III, DMD
Dentist in Great Lakes, IL. Individual provider (NPI-1).
NPI number1780160556
StatusActive
Last updated in NPPESJul 16, 2018
Details
- NPI
- 1780160556
- Entity type
- Individual (NPI-1)
- Name
- Dr. Clinton Bissell Butler III
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 16, 2018
- Last updated
- Jul 16, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 9171 | SC | Yes |
Practice location
2410 Sampson StGreat Lakes, IL 60088-2942
Phone 847-688-3331
Mailing address
322 68th StKenosha, WI 53143-5132
Phone 803-767-0032
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