Provider Demographics
NPI:1770857039
Name:ANTHONY ANHTUAN LY D.D.S., P.A.
Entity Type:Organization
Organization Name:ANTHONY ANHTUAN LY D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RASHAY
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAMBLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-558-3759
Mailing Address - Street 1:840 N ELDRIDGE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2704
Mailing Address - Country:US
Mailing Address - Phone:281-558-3759
Mailing Address - Fax:281-558-6484
Practice Address - Street 1:840 N ELDRIDGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2704
Practice Address - Country:US
Practice Address - Phone:281-558-3759
Practice Address - Fax:281-558-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18013305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization