Individual
ALYSSA LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4352 MANCHESTER AVE, SAINT LOUIS, MO 63110-2138
(314) 371-0336
Mailing address
401 HOLLY HILLS AVE, SAINT LOUIS, MO 63111-2410
(314) 353-5190
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2023025120
MO
Other
Enumeration date
07/27/2023
Last updated
09/10/2023
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