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General NPI Number Information
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NPI Number | 1861609026
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Entity Type | Organization
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Legal Business Name | BUI & ENRIQUEZ DENTAL CORPORATION
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 88 W. TULLY RD. UNIT #115
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City | SAN JOSE
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State | CA
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Zip | 95111
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Country | US
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Telephone | 408-225-1885
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Fax |
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Provider Business Mailing Address
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Address Line | 21500 BERTRAM RD
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City | SAN JOSE
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State | CA
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Zip | 95120-4324
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Country | US
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Telephone | 408-225-1888
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. VICTOR M ENRIQUEZ
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Credential | D.D.S.
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Telephone | 408-225-1885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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