Provider Demographics
NPI:1568489219
Name:LY, ANH NGOC (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANH
Middle Name:NGOC
Last Name:LY
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 1:908 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3903
Mailing Address - Country:US
Mailing Address - Phone:215-238-5727
Mailing Address - Fax:215-413-0729
Practice Address - Street 1:908 S 8TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-3903
Practice Address - Country:US
Practice Address - Phone:215-238-5727
Practice Address - Fax:215-413-0729
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-029735-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice