Healthcare Provider Details

I. General information

NPI: 1841786589
Provider Name (Legal Business Name): MANNHU BUI IGLESIAS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MANNHU TRUONG BUI DDS

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9820 BRAUN RD STE 101
SAN ANTONIO TX
78254-9657
US

IV. Provider business mailing address

804 E UPAS AVE APT A
MCALLEN TX
78501-2391
US

V. Phone/Fax

Practice location:
  • Phone: 214-466-1400
  • Fax: 214-367-5896
Mailing address:
  • Phone: 832-348-9438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number34308
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: