Provider Demographics
NPI:1538314372
Name:CAVITYBUSTERS
Entity Type:Organization
Organization Name:CAVITYBUSTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QUANG
Authorized Official - Middle Name:MD
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-362-5437
Mailing Address - Street 1:6910 S RAINBOW BLVD
Mailing Address - Street 2:#104
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3273
Mailing Address - Country:US
Mailing Address - Phone:702-362-5437
Mailing Address - Fax:702-631-5437
Practice Address - Street 1:6910 S RAINBOW BLVD
Practice Address - Street 2:#104
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3273
Practice Address - Country:US
Practice Address - Phone:702-362-5437
Practice Address - Fax:702-631-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS5-621223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1043396906Medicaid
NV880491583Medicaid
NV=========Medicaid