Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 18013 | TX |
NPI | 1285622761 |
---|---|
Provider Name | Anthony Anhtuan Ly |
First Address | Houston, TX 77095-1916 |
Second Address | Houston, TX 77095-1916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 10/02/2021 |