Provider Demographics
NPI:1558084186
Name:BUI, PHILIP THUC (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:THUC
Last Name:BUI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:11 GARDENIA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1984
Mailing Address - Country:US
Mailing Address - Phone:714-900-1135
Mailing Address - Fax:
Practice Address - Street 1:9610 SIERRA AVE, FONTANA, CA 92335
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335
Practice Address - Country:US
Practice Address - Phone:909-219-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108046122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist