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General NPI Number Information
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NPI Number | 1174956528
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Entity Type | Organization
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Legal Business Name | DAI BUI FAMILY DENTISTRY
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 08/20/2013
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Provider Practice Location Address
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Address Line | 8851 CENTRAL AVE STE D
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City | MONTCLAIR
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State | CA
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Zip | 91763-1658
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Country | US
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Telephone | 909-625-5357
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Fax | 909-625-5857
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Provider Business Mailing Address
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Address Line | 8851 CENTRAL AVE STE D
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City | MONTCLAIR
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State | CA
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Zip | 91763-1658
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Country | US
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Telephone | 909-625-5357
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Fax | 909-625-5857
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JOSE PALACIOS
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Credential |
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Telephone | 909-625-5357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 46031
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License Number State | CA
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