Provider Demographics
NPI:1922216126
Name:BUI, THOA THI (DDS)
Entity Type:Individual
Prefix:
First Name:THOA
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 1:20025 LAKE FOREST DR STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8716
Mailing Address - Country:US
Mailing Address - Phone:949-595-4322
Mailing Address - Fax:
Practice Address - Street 1:20025 LAKE FOREST DR STE 105
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8716
Practice Address - Country:US
Practice Address - Phone:949-595-4322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA484321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice