Provider Demographics
NPI:1831404417
Name:BUI, SHAWN XUAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:XUAN
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 1:3125 SANTA ANNA AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-1755
Mailing Address - Country:US
Mailing Address - Phone:214-924-3160
Mailing Address - Fax:
Practice Address - Street 1:905 N JUPITER RD STE 180
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-7713
Practice Address - Country:US
Practice Address - Phone:972-234-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-08
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216290107Medicaid