Provider Demographics
NPI:1124178322
Name:BUGHAO AND CHU DENTAL A GENERAL PARTNERSHIP
Entity type:Organization
Organization Name:BUGHAO AND CHU DENTAL A GENERAL PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUGHAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-718-4901
Mailing Address - Street 1:1035 SUNCAST LANE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9658
Mailing Address - Country:US
Mailing Address - Phone:916-941-0323
Mailing Address - Fax:916-941-0325
Practice Address - Street 1:1035 SUNCAST LANE
Practice Address - Street 2:SUITE 110
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9658
Practice Address - Country:US
Practice Address - Phone:916-941-0323
Practice Address - Fax:916-941-0325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB355971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9401901Medicaid