Provider Demographics
NPI:1831676022
Name:BUI, JIMMY (DDS)
Entity Type:Individual
Prefix:
First Name:JIMMY
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 1:2126 COGBURN PARK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-4667
Mailing Address - Country:US
Mailing Address - Phone:214-762-9210
Mailing Address - Fax:
Practice Address - Street 1:3800 N SHEPHERD DR # 3-A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-6400
Practice Address - Country:US
Practice Address - Phone:713-322-3898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34114122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist