Healthcare Provider Details

I. General information

NPI: 1538314372
Provider Name (Legal Business Name): CAVITYBUSTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6910 S RAINBOW BLVD #104
LAS VEGAS NV
89118-3273
US

IV. Provider business mailing address

6910 S RAINBOW BLVD #104
LAS VEGAS NV
89118-3273
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 TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberS5-62
License Number StateNV

VIII. Authorized Official

Name: QUANG M.D. BUI
Title or Position: OWNER
Credential: D.M.D.
Phone: 702-362-5437