Provider Demographics
NPI:1376977819
Name:BUI, VAN THUY THI (DMD)
Entity Type:Individual
Prefix:DR
First Name:VAN THUY
Middle Name:THI
Last Name:BUI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:THUY
Other - Middle Name:THI
Other - Last Name:BUI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:11232 E LINCOLNSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4479
Mailing Address - Country:US
Mailing Address - Phone:217-840-4427
Mailing Address - Fax:
Practice Address - Street 1:401 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-3442
Practice Address - Country:US
Practice Address - Phone:217-868-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-31
Last Update Date:2013-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190296071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice