Provider Demographics
NPI:1417153370
Name:CHAN-LY, ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:
Last Name:CHAN-LY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20854 CROSS ISLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1187
Mailing Address - Country:US
Mailing Address - Phone:917-751-4590
Mailing Address - Fax:718-631-0508
Practice Address - Street 1:20854 CROSS ISLAND PKWY
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1187
Practice Address - Country:US
Practice Address - Phone:718-631-0508
Practice Address - Fax:718-631-0509
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053963-1122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist