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General NPI Number Information
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NPI Number | 1801387444
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Entity Type | Organization
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Legal Business Name | T. BUI DENTAL CORPORATION
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 1701 CORPORATE DR STE C3
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City | LADERA RANCH
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State | CA
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Zip | 92694-2126
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Country | US
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Telephone | 949-324-4456
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Fax |
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Provider Business Mailing Address
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Address Line | 31161 VIA CONSUELO
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City | COTO DE CAZA
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State | CA
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Zip | 92679-4017
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Country | US
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Telephone | 714-260-3179
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Fax |
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Authorized Official
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Title or Position | PRESIDETN
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Name | THINH VAN BUI
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Credential | DDS
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Telephone | 714-260-3179
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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 | 49729
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License Number State | CA
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