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Organization
PRIMARY DENTAL CLINIC, P.A.
Active
Organization
PRIMARY DENTAL CLINIC, P.A.
Active
Other names
Primary Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIM BUI DDS (SECRETARY)
(469) 939-6691
Entity
Organization
Contact information
Practice address
6871 SHADYBROOK LN, DALLAS, TX 75231-6605
(469) 939-6691
Mailing address
1906 VILLAGE CREEK DR, GARLAND, TX 75040-3946
(469) 939-6691
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
21598
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176322901
—
TX
01
—
21598
SBDE TX DENTIST PROVIDER NUMBER
TX
01
—
B21598-01
TEXAS CHIP
TX
Enumeration date
01/04/2007
Last updated
03/20/2014
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