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Organization
TK LY DENTAL CORPORATION
Active
Organization
TK LY DENTAL CORPORATION
Active
Other names
BAY MESA DENTAL OFFICE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TUANKIET QUOC LY D.D.S (PRESIDENT)
(949) 646-9000
Entity
Organization
Contact information
Practice address
2023 HARBOR BLVD, SUITE D, COSTA MESA, CA 92627-5552
(949) 646-9000
Mailing address
2023 HARBOR BLVD, SUITE D, COSTA MESA, CA 92627-5552
(949) 646-9000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
48322
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043387228
NATIONAL PROVIDER IDENTIFIER
CA
01
—
48322
DENTAL BOARD OF CALIFORNIA
CA
Enumeration date
01/05/2010
Last updated
01/05/2010
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