Provider Demographics
NPI:1396924197
Name:BUI, TAN DUY (DDS)
Entity type:Individual
Prefix:
First Name:TAN
Middle Name:DUY
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 1:12600 SCARSDALE BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6271
Mailing Address - Country:US
Mailing Address - Phone:281-484-3992
Mailing Address - Fax:281-484-3995
Practice Address - Street 1:12600 SCARSDALE BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6271
Practice Address - Country:US
Practice Address - Phone:281-484-3992
Practice Address - Fax:281-484-3995
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX175361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice