Provider Demographics
NPI:1871656512
Name:BUI, ASHLEY O (DDS)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:O
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 1:4837 N 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-3011
Mailing Address - Country:US
Mailing Address - Phone:602-242-5406
Mailing Address - Fax:602-242-5407
Practice Address - Street 1:4837 N 35TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-3011
Practice Address - Country:US
Practice Address - Phone:602-242-5406
Practice Address - Fax:602-242-5407
Is Sole Proprietor?:No
Enumeration Date:2006-12-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ 50731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ480468Medicaid