Provider Demographics
NPI:1073681086
Name:BUI, JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:BUI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 W KETTLEMAN LN
Mailing Address - Street 2:SUITE 47
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-6031
Mailing Address - Country:US
Mailing Address - Phone:209-224-8104
Mailing Address - Fax:
Practice Address - Street 1:1110 W KETTLEMAN LN
Practice Address - Street 2:SUITE 47
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-6031
Practice Address - Country:US
Practice Address - Phone:109-518-6315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice