Individual provider Active NPI

Bryan Quoc Bui, DMD

  • General Practice Dentistry
  • Atlanta, GA
National Provider Identifier
1972625598
Registry record updated Jul 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN015536 Issued in GA
Practice address
4054 Buford Hwy NE
Atlanta, GA 30345-1678
Phone
(404) 477-5665
Fax
(404) 477-5666
NPI assigned
Apr 4, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 48089 CA
General Practice Dentistry 1223G0001X DN015536 GA Primary

Addresses

Primary practice location

4054 Buford Hwy NE
Atlanta, GA 30345-1678

Mailing address

715 Creek Wind CT
Duluth, GA 30097-7149
Phone (510) 862-5353

Other practice location 1

1000 N Midkiff Rd Ste B-6
Midland, TX 79701-2101
Phone (510) 862-5353

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170525002344 CA Order and Referring Only - DentistPractitioner - Oral SurgeryPractitioner - Dentist 9931476785

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Candler Road Dental, PC General Practice Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562889600000",
    "number": "1972625598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 CREEK WIND CT",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300977149",
            "telephone_number": "510-862-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4054 BUFORD HWY NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303451678",
            "telephone_number": "404-477-5665",
            "fax_number": "404-477-5666"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 N Midkiff Rd Ste B-6",
            "address_purpose": "LOCATION",
            "city": "Midland",
            "state": "TX",
            "postal_code": "797012101",
            "country_code": "US",
            "telephone_number": "510-862-5353",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUI",
        "first_name": "BRYAN",
        "middle_name": "QUOC",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-04",
        "last_updated": "2019-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "48089",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN015536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.