Provider Demographics
NPI:1518928928
Name:BUI, LONG K (DDS)
Entity Type:Individual
Prefix:DR
First Name:LONG
Middle Name:K
Last Name:BUI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 E FRY BLVD
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2625
Mailing Address - Country:US
Mailing Address - Phone:520-459-5166
Mailing Address - Fax:520-458-8425
Practice Address - Street 1:833 E FRY BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2625
Practice Address - Country:US
Practice Address - Phone:520-459-5166
Practice Address - Fax:520-458-8425
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ57641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice