Provider Demographics
NPI:1003254004
Name:TUAN T. LY DDS, INC
Entity Type:Organization
Organization Name:TUAN T. LY DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-745-0593
Mailing Address - Street 1:910 E GRAND AVE
Mailing Address - Street 2:A
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3430
Mailing Address - Country:US
Mailing Address - Phone:760-745-0593
Mailing Address - Fax:760-745-0633
Practice Address - Street 1:910 E GRAND AVE
Practice Address - Street 2:A
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3430
Practice Address - Country:US
Practice Address - Phone:760-745-0593
Practice Address - Fax:760-745-0633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571691223P0221X
NY0523431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty