Provider Demographics
NPI:1649335852
Name:BUI AND ENRIQUEZ DENTAL CORPORATION
Entity type:Organization
Organization Name:BUI AND ENRIQUEZ DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:ENRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-225-1885
Mailing Address - Street 1:485 LEWIS ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111
Mailing Address - Country:US
Mailing Address - Phone:408-225-1885
Mailing Address - Fax:
Practice Address - Street 1:485 LEWIS RD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111
Practice Address - Country:US
Practice Address - Phone:408-225-1885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC27140781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty