Provider Demographics
NPI:1710556071
Name:BUI, TAN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAN
Middle Name:M
Last Name:BUI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 FALLS BAY CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-3305
Mailing Address - Country:US
Mailing Address - Phone:121-061-6121
Mailing Address - Fax:
Practice Address - Street 1:2937 COBB PKWY SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3519
Practice Address - Country:US
Practice Address - Phone:315-454-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist