Provider Demographics
NPI:1710038369
Name:BUI, THY A (DMD)
Entity type:Individual
Prefix:DR
First Name:THY
Middle Name:A
Last Name:BUI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PARK PL
Mailing Address - Street 2:SUITE 215
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1764
Mailing Address - Country:US
Mailing Address - Phone:716-672-4363
Mailing Address - Fax:
Practice Address - Street 1:1 PARK PL
Practice Address - Street 2:SUITE 215
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1764
Practice Address - Country:US
Practice Address - Phone:716-672-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048731-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02072324Medicaid