Provider Demographics
NPI:1467745836
Name:LY, THANG M (DDS)
Entity Type:Individual
Prefix:DR
First Name:THANG
Middle Name:M
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 1:1753 W SAN CARLOS ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-5222
Mailing Address - Country:US
Mailing Address - Phone:408-999-0707
Mailing Address - Fax:408-999-0135
Practice Address - Street 1:1753 W SAN CARLOS ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-5222
Practice Address - Country:US
Practice Address - Phone:408-999-0707
Practice Address - Fax:408-999-0135
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50951122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist