Healthcare Provider Details

I. General information

NPI: 1144036153
Provider Name (Legal Business Name): AN DUY BUI, DMD, A PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 N CAPITOL AVE STE 140
SAN JOSE CA
95132-2500
US

IV. Provider business mailing address

1155 N CAPITOL AVE STE 140
SAN JOSE CA
95132-2500
US

V. Phone/Fax

Practice location:
  • Phone: 408-729-5596
  • Fax:
Mailing address:
  • Phone: 408-729-5596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. AN DUY BUI
Title or Position: PRESIDENT
Credential: DMD
Phone: 408-318-3765