Provider Demographics
NPI:1972625598
Name:BUI, BRYAN QUOC (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:QUOC
Last Name:BUI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 CREEK WIND CT
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-7149
Mailing Address - Country:US
Mailing Address - Phone:510-862-5353
Mailing Address - Fax:
Practice Address - Street 1:4054 BUFORD HWY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-1678
Practice Address - Country:US
Practice Address - Phone:404-477-5665
Practice Address - Fax:404-477-5666
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48089122300000X
GADN0155361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist