Provider Demographics
NPI:1699424770
Name:BUI, PHUONG CAT (DDS)
Entity type:Individual
Prefix:
First Name:PHUONG
Middle Name:CAT
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 1:814 S 37TH AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-1164
Mailing Address - Country:US
Mailing Address - Phone:515-822-6889
Mailing Address - Fax:
Practice Address - Street 1:1860 MADISON AVE STE 4
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-5200
Practice Address - Country:US
Practice Address - Phone:515-822-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS620381223G0001X
390200000X
IADDS-099781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program