Provider Demographics
NPI:1518140854
Name:BLY, ERICA S (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:S
Last Name:BLY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 WESTCHESTER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2510
Mailing Address - Country:US
Mailing Address - Phone:914-996-7786
Mailing Address - Fax:914-459-5504
Practice Address - Street 1:3020 WESTCHESTER AVE FL 2
Practice Address - Street 2:
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2510
Practice Address - Country:US
Practice Address - Phone:914-996-7786
Practice Address - Fax:914-595-5044
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0518301223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry