Provider Demographics
NPI:1669765228
Name:BUI, STACEY BICHDAO (DDS)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:BICHDAO
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 1:2041 PIONEER CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1786
Mailing Address - Country:US
Mailing Address - Phone:650-345-2676
Mailing Address - Fax:650-345-2677
Practice Address - Street 1:2041 PIONEER CT
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1786
Practice Address - Country:US
Practice Address - Phone:650-345-2676
Practice Address - Fax:650-345-2677
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA587421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA58742OtherDENTAL LICENSE