Provider Demographics
NPI:1497151724
Name:DING BU DDS DENTAL CORP
Entity Type:Organization
Organization Name:DING BU DDS DENTAL CORP
Other - Org Name:DING BU DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-285-9808
Mailing Address - Street 1:5546 ROSEMEAD BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-1845
Mailing Address - Country:US
Mailing Address - Phone:626-285-9808
Mailing Address - Fax:626-285-6878
Practice Address - Street 1:5546 ROSEMEAD BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-1845
Practice Address - Country:US
Practice Address - Phone:626-285-9808
Practice Address - Fax:626-285-6878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45829261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4582901Medicaid