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General NPI Number Information
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NPI Number | 1316495880
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Entity Type | Organization
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Legal Business Name | LY DENTAL CORPORATION
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 9938 BOLSA AVE STE 106
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City | WESTMINSTER
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State | CA
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Zip | 92683-6039
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Country | US
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Telephone | 714-305-5199
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Fax |
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Provider Business Mailing Address
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Address Line | 9938 BOLSA AVE STE 106
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City | WESTMINSTER
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State | CA
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Zip | 92683-6039
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Country | US
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Telephone | 714-305-5199
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. QUY VAN LY
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Credential | DDS
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Telephone | 714-305-5199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 40665
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License Number State | CA
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