Healthcare Provider Details

I. General information

NPI: 1780590760
Provider Name (Legal Business Name): DUONG DAI LY PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 KRESKY AVE
CENTRALIA WA
98531-8979
US

IV. Provider business mailing address

1407 KRESKY AVE
CENTRALIA WA
98531-8979
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-9397
  • Fax:
Mailing address:
  • Phone: 360-736-9397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DUONG D LY
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 206-618-4496