Provider Demographics
NPI:1760550453
Name:BUI, PHU THI (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHU
Middle Name:THI
Last Name:BUI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 SW CEDAR HILLS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2013
Mailing Address - Country:US
Mailing Address - Phone:503-644-8727
Mailing Address - Fax:503-644-8901
Practice Address - Street 1:4350 SW CEDAR HILLS BLVD STE B
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2013
Practice Address - Country:US
Practice Address - Phone:503-644-8727
Practice Address - Fax:503-644-8901
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7308122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist