Provider Demographics
NPI:1407908569
Name:BUADO, THELMA BRILLANTES (DDS)
Entity Type:Individual
Prefix:DR
First Name:THELMA
Middle Name:BRILLANTES
Last Name:BUADO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 E AVENUE S
Mailing Address - Street 2:SUITE A-14
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-2414
Mailing Address - Country:US
Mailing Address - Phone:661-265-7634
Mailing Address - Fax:661-266-0861
Practice Address - Street 1:3025 E AVENUE S
Practice Address - Street 2:SUITE A-14
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-2414
Practice Address - Country:US
Practice Address - Phone:661-265-7634
Practice Address - Fax:661-266-0861
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA415901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice