Provider Demographics
NPI:1689026452
Name:LY, THY (DMD)
Entity Type:Individual
Prefix:DR
First Name:THY
Middle Name:
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 1:9301 E SHEA BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6735
Mailing Address - Country:US
Mailing Address - Phone:602-561-8955
Mailing Address - Fax:
Practice Address - Street 1:9301 E SHEA BLVD STE 111
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6735
Practice Address - Country:US
Practice Address - Phone:602-561-8955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0095281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice