MEDICARE: TAMMY LY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7362	LA
2	1223G0001X	General Practice Dentistry	38787	TX

General Provider Information

NPI Number	:	1104551779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY LY DDS

Provider Business Mailing Address
First Line	:	5225 ELLIOTT RD APT 1115
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 MAPLEWOOD DR
Second Line	:
City	:	SULPHUR
State	:	LA
Zip	:	70663-6114
Country	:	US
Telephone Number	:	337-625-2671
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2022
Last Update Date	:	03/04/2026

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Directions to “ TAMMY LY DDS” Practice Location

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