Healthcare Provider Details

I. General information

NPI: 1043396906
Provider Name (Legal Business Name): QUANG DANG MINH BUI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 12/01/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5980 S JONES BLVD
LAS VEGAS NV
89118
US

IV. Provider business mailing address

5980 S JONES BLVD
LAS VEGAS NV
89118
US

V. Phone/Fax

Practice location:
  • Phone: 702-362-5437
  • Fax: 702-631-5437
Mailing address:
  • Phone: 702-362-5437
  • Fax: 702-631-5437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3723
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberS6-52
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: