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General NPI Number Information
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NPI Number | 1245471291
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Entity Type | Organization
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Legal Business Name | NORTHWEST DENTISTRY
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Dates
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Enumeration Date | 03/19/2009
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Last Update Date | 03/19/2009
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Provider Practice Location Address
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Address Line | 6676 N NORTHWEST HWY SUITE 1
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City | CHICAGO
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State | IL
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Zip | 60631-1306
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Country | US
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Telephone | 773-631-6677
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Fax | 773-631-6679
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Provider Business Mailing Address
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Address Line | 6676 N NORTHWEST HWY SUITE 1
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City | CHICAGO
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State | IL
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Zip | 60631-1306
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Country | US
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Telephone | 773-631-6677
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Fax | 773-631-6679
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Authorized Official
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Title or Position | OWNER
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Name | DR. THAO HOAI BUI
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Credential | DMD
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Telephone | 773-631-6677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019026286
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License Number State | IL
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