=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093030249
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUANG D M BUI PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2010
-----------------------------------------------------
Last Update Date | 03/31/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 N BUFFALO DR SUITE B
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89145-0302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-869-8858
-----------------------------------------------------
Fax | 702-869-5588
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 N BUFFALO DR SUITE B
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89145-0302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-869-8858
-----------------------------------------------------
Fax | 702-869-5588
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. TERESA SUE WESTFALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-869-8858
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | S6-52
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------