Provider Demographics
NPI:1093030249
Name:QUANG D M BUI PC
Entity Type:Organization
Organization Name:QUANG D M BUI PC
Other - Org Name:CAVITYBUSTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:WESTFALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-869-8858
Mailing Address - Street 1:211 N BUFFALO DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-0302
Mailing Address - Country:US
Mailing Address - Phone:702-869-8858
Mailing Address - Fax:702-869-5588
Practice Address - Street 1:211 N BUFFALO DR
Practice Address - Street 2:SUITE B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-0302
Practice Address - Country:US
Practice Address - Phone:702-869-8858
Practice Address - Fax:702-869-5588
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAVITYBUSTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6-521223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100511579Medicaid