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NPI Code Detail

MEDICARE: DR. SALLY LY DMD

MEDICARE: DR. SALLY LY DMD
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
11223G0001XGeneral Practice Dentistry7071NV

General Provider Information

NPI Number : 1679068498
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SALLY LY DMD
Provider Business Mailing Address
First Line : 6180 N DECATUR BLVD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-1505
Country : US
Telephone Number : 702-359-3107
Fax Number :
Provider Business Practice Location Address
First Line : 6180 N DECATUR BLVD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-1505
Country : US
Telephone Number : 702-359-3107
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2018
Last Update Date : 06/25/2018

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Directions to “ DR. SALLY LY DMD” Practice Location

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