Provider Demographics
NPI:1891902375
Name:BUI DENTAL CORPORATION
Entity Type:Organization
Organization Name:BUI DENTAL CORPORATION
Other - Org Name:VITALAE DENTAL SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:DINHLUU
Authorized Official - Last Name:BREDEHOFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-748-6220
Mailing Address - Street 1:2500 ALTON PKWY STE 208
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5034
Mailing Address - Country:US
Mailing Address - Phone:949-748-6220
Mailing Address - Fax:949-748-6225
Practice Address - Street 1:2500 ALTON PKWY STE 208
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5034
Practice Address - Country:US
Practice Address - Phone:949-748-6220
Practice Address - Fax:949-748-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty