Provider Demographics
NPI:1154948453
Name:NGO, LY PHUONG THI (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:LY
Middle Name:PHUONG THI
Last Name:NGO
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12880 PINEFOREST WAY W
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-1722
Mailing Address - Country:US
Mailing Address - Phone:727-252-9608
Mailing Address - Fax:
Practice Address - Street 1:1210 MILLERSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-6656
Practice Address - Country:US
Practice Address - Phone:717-299-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS042875122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist