Provider Demographics
NPI:1336344076
Name:LY, DANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:LY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 BRUTON TERRACE CTR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-8376
Mailing Address - Country:US
Mailing Address - Phone:214-275-9090
Mailing Address - Fax:214-275-9191
Practice Address - Street 1:9009 BRUTON RD
Practice Address - Street 2:#435
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-2042
Practice Address - Country:US
Practice Address - Phone:214-275-9090
Practice Address - Fax:215-275-9191
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice