MEDICARE: ANTHONY ANHTUAN LY D.D.S., P.A.

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	305R00000X	Preferred Provider Organization	18013	TX

General Provider Information

NPI Number	:	1770857039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY ANHTUAN LY D.D.S., P.A.

Provider Business Mailing Address
First Line	:	840 N ELDRIDGE PKWY
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77079-2704
Country	:	US
Telephone Number	:	281-558-3759
Fax Number	:	281-558-6484

Provider Business Practice Location Address
First Line	:	840 N ELDRIDGE PKWY
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77079-2704
Country	:	US
Telephone Number	:	281-558-3759
Fax Number	:	281-558-6484

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	RASHAY STRAMBLER
Credential	:
Telephone Number	:	281-558-3759

Provider Enumeration Date	:	03/05/2012
Last Update Date	:	03/05/2012

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