Provider Demographics
NPI:1023890910
Name:BUI, CAC THANH
Entity type:Individual
Prefix:
First Name:CAC
Middle Name:THANH
Last Name:BUI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46161 WESTLAKE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5871
Mailing Address - Country:US
Mailing Address - Phone:571-450-9848
Mailing Address - Fax:
Practice Address - Street 1:46161 WESTLAKE DR STE 100
Practice Address - Street 2:
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165-5871
Practice Address - Country:US
Practice Address - Phone:571-450-9848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014186201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice