Provider Demographics
NPI:1881194348
Name:LIEN K. LY, DDS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LIEN K. LY, DDS, A PROFESSIONAL CORPORATION
Other - Org Name:SKY CANYON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-677-6608
Mailing Address - Street 1:39040 SKY CANYON DR STE 107
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3515
Mailing Address - Country:US
Mailing Address - Phone:951-677-6608
Mailing Address - Fax:
Practice Address - Street 1:39040 SKY CANYON DR STE 107
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-3515
Practice Address - Country:US
Practice Address - Phone:951-677-6608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental