MEDICARE: ANTHONY ANHTUAN 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	1223D0001X	Public Health Dentistry	18013	TX

General Provider Information

NPI Number	:	1285622761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY ANHTUAN LY DDS

Provider Business Mailing Address
First Line	:	15218 WEST RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-1916
Country	:	US
Telephone Number	:	281-550-7276
Fax Number	:	281-840-6057

Provider Business Practice Location Address
First Line	:	15218 WEST RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-1916
Country	:	US
Telephone Number	:	281-550-7276
Fax Number	:

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	02/10/2021

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