Healthcare Provider Details

I. General information

NPI: 1720322431
Provider Name (Legal Business Name): AMERICAREDENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 SW CEDAR HILLS BLVD STE B
BEAVERTON OR
97005-2013
US

IV. Provider business mailing address

4350 SW CEDAR HILLS BLVD. STE. B
BEAVERTON OR
97005-2013
US

V. Phone/Fax

Practice location:
  • Phone: 503-644-8727
  • Fax:
Mailing address:
  • Phone: 503-644-8727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberD7308
License Number StateOR

VIII. Authorized Official

Name: DR. PHU THI BUI
Title or Position: PRESIDENT/DENTIST
Credential: DDS
Phone: 503-644-8727