Provider Demographics
NPI:1275762064
Name:LY, DUY TRI (DDS)
Entity Type:Individual
Prefix:DR
First Name:DUY
Middle Name:TRI
Last Name:LY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5677 TREASCHWIG RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-7162
Mailing Address - Country:US
Mailing Address - Phone:281-645-4205
Mailing Address - Fax:281-645-4565
Practice Address - Street 1:117 SOUTHPOINT LOOP
Practice Address - Street 2:STE 400
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-8899
Practice Address - Country:US
Practice Address - Phone:936-327-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26292122300000X
CA59795122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist