MEDICARE: DR. NANCY DINH 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	1223P0221X	Pediatric Dentistry	7233	LA

General Provider Information

NPI Number	:	1134743990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY DINH LY DDS

Provider Business Mailing Address
First Line	:	4325 AIRLINE DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-2003
Country	:	US
Telephone Number	:	318-742-9333
Fax Number	:

Provider Business Practice Location Address
First Line	:	4325 AIRLINE DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-2003
Country	:	US
Telephone Number	:	318-742-9333
Fax Number	:

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

Provider Enumeration Date	:	06/07/2020
Last Update Date	:	04/07/2025

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