Individual
DR. PHAT T LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
8507 S 5TH ST # A-101, RIDGEFIELD, WA 98642-3421
(360) 887-2310
(360) 887-2309
Mailing address
8507 S 5TH ST # A-101, RIDGEFIELD, WA 98642-3421
(360) 887-2310
(360) 887-2309
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00010063
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5047634
—
WA
Enumeration date
01/30/2007
Last updated
12/09/2021
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