Active NPI
Richard Ly
- General Practice Dentistry
- San Benito, TX
National Provider Identifier
1639684913
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 33646
- Practice address
- 1141 W US Highway 77 Ste G
San Benito, TX 78586-4398 - Phone
- (956) 413-7539
- NPI assigned
- Dec 7, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 33646 | TX | Primary |
Addresses
Primary practice location
1141 W US Highway 77 Ste G
San Benito, TX 78586-4398
Mailing address
3201 Goldridge CT
San Jose, CA 95135-2014
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33646 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512604800000",
"number": "1639684913",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3201 GOLDRIDGE CT",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951352014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1141 W US HIGHWAY 77 STE G",
"city": "SAN BENITO",
"state": "TX",
"postal_code": "785864398",
"telephone_number": "956-413-7539"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "RICHARD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-12-07",
"last_updated": "2017-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "33646",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Benito, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.