Phat T Ly, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00010063 Issued in WA

Practice address

8507 S 5TH St # a-101
Ridgefield, WA 98642-3421

Phone

(360) 887-2310

Fax

(360) 887-2309

NPI assigned

Jan 30, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Phat Ly DMD PLLC

  • Dentist
  • Ridgefield, WA
  • NPI 1841958626
  NPD Authorized official
• J Winger, DDS, PLLC

  • General Practice Dentistry
  • Vancouver, WA
  • NPI 1134093065
  NPD (past)
• Wendel Family Dental Centre PS

  • General Practice Dentistry
  • Vancouver, WA
  • NPI 1295844900
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639008000000",
    "number": "1720125966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8507 S 5TH ST # A-101",
            "city": "RIDGEFIELD",
            "state": "WA",
            "postal_code": "986423421",
            "telephone_number": "360-887-2310",
            "fax_number": "360-887-2309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8507 S 5TH ST # A-101",
            "city": "RIDGEFIELD",
            "state": "WA",
            "postal_code": "986423421",
            "telephone_number": "360-887-2310",
            "fax_number": "360-887-2309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LY",
        "first_name": "PHAT",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00010063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5047634",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lori Hughes Nutrition Consulting LLC
• Arthur William Lowe, LMP
• Danielle Luiz
• Kimberlee Lundgren
• Jeannette V Luther, PA-C
• Edwina Laverne Lyon, LPN
• McKenna Mackintosh, DPT
• Bethany Manor
• Denise Christine Marler, RDH
• Carrie Martinsen

• General Practice Dentistry in Ridgefield, WA
• Providers in Ridgefield, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.