Provider Demographics
NPI:1720380934
Name:BUI, THO (DDS)
Entity Type:Individual
Prefix:DR
First Name:THO
Middle Name:
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 1:591 FALLEN LEAF CIR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-5305
Mailing Address - Country:US
Mailing Address - Phone:682-552-3102
Mailing Address - Fax:
Practice Address - Street 1:591 FALLEN LEAF CIR
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5305
Practice Address - Country:US
Practice Address - Phone:682-552-3102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257331223G0001X
CA621101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice