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General NPI Number Information
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NPI Number | 1255715157
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Entity Type | Organization
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Legal Business Name | JOSEPH PHUOC BUI DMD INC
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Dates
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Enumeration Date | 07/10/2015
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 1110 W KETTLEMAN LN STE 47
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City | LODI
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State | CA
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Zip | 95240-6031
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Country | US
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Telephone | 209-224-8104
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 W KETTLEMAN LN SUITE 47
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City | LODI
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State | CA
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Zip | 95240-6031
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/MANAGING DENTIST
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Name | DR. JOSEPH BUI
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Credential | DMD
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Telephone | 209-518-6315
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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 | 54638
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License Number State | CA
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