=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811188857
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SON NGUYEN BUI D.M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2007
-----------------------------------------------------
Last Update Date | 01/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14820 PACIFIC AVE S
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98444-4655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-200-4155
-----------------------------------------------------
Fax | 253-200-4154
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14820 PACIFIC AVE S
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98444-4655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-200-4155
-----------------------------------------------------
Fax | 253-200-4154
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DE00010979
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 21811
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 23652
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------