MEDICARE: DING BU DDS DENTAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	45829	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497151724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DING BU DDS DENTAL CORP

Provider Business Mailing Address
First Line	:	5546 ROSEMEAD BLVD
Second Line	:	SUITE 104
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-1845
Country	:	US
Telephone Number	:	626-285-9808
Fax Number	:	626-285-6878

Provider Business Practice Location Address
First Line	:	5546 ROSEMEAD BLVD
Second Line	:	SUITE 104
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-1845
Country	:	US
Telephone Number	:	626-285-9808
Fax Number	:	626-285-6878

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DEAN BU
Credential	:	DDS
Telephone Number	:	626-285-9808

Provider Enumeration Date	:	11/13/2014
Last Update Date	:	11/13/2014

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