Provider Demographics
NPI:1801387444
Name:T. BUI DENTAL CORPORATION
Entity Type:Organization
Organization Name:T. BUI DENTAL CORPORATION
Other - Org Name:LADERA SMILE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDETN
Authorized Official - Prefix:
Authorized Official - First Name:THINH
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-260-3179
Mailing Address - Street 1:31161 VIA CONSUELO
Mailing Address - Street 2:
Mailing Address - City:COTO DE CAZA
Mailing Address - State:CA
Mailing Address - Zip Code:92679-4017
Mailing Address - Country:US
Mailing Address - Phone:714-260-3179
Mailing Address - Fax:
Practice Address - Street 1:1701 CORPORATE DR STE C3
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2126
Practice Address - Country:US
Practice Address - Phone:949-324-4456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49729122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty