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General NPI Number Information
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NPI Number | 1669529798
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Entity Type | Organization
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Legal Business Name | PRIMARY DENTAL CLINIC, P.A.
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 03/20/2014
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Provider Practice Location Address
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Address Line | 6871 SHADYBROOK LN
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City | DALLAS
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State | TX
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Zip | 75231-6605
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Country | US
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Telephone | 469-939-6691
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Fax |
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Provider Business Mailing Address
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Address Line | 1906 VILLAGE CREEK DR
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City | GARLAND
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State | TX
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Zip | 75040-3946
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Country | US
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Telephone | 469-939-6691
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. KIM BUI
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Credential | DDS
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Telephone | 469-939-6691
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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 | 21598
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License Number State | TX
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