Provider Demographics
NPI:1669783908
Name:BUI, TUONG THAO T (DMD)
Entity type:Individual
Prefix:DR
First Name:TUONG THAO
Middle Name:T
Last Name:BUI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:THAO
Other - Middle Name:
Other - Last Name:BUI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:815 CUTTING HORSE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2469
Mailing Address - Country:US
Mailing Address - Phone:314-489-2050
Mailing Address - Fax:
Practice Address - Street 1:4828 COLUMBIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1011
Practice Address - Country:US
Practice Address - Phone:214-823-0202
Practice Address - Fax:214-824-6464
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice