Phong Ly, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D13699 Issued in MN

Practice address

9920 Foley Blvd NW Ste 110
Coon Rapids, MN 55433-5216

Phone

(763) 377-2110

NPI assigned

May 10, 2016

Last updated

Nov 12, 2025By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in MN

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

Locations

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

• PL Dental SC

  • Dental Clinic/Center
  • Zimmerman, MN
  • NPI 1225786411
  NPD Authorized official
• PL Dental SC

  • Dental Clinic/Center
  • Coon Rapids, MN
  • NPI 1952140691
  NPD Authorized official
• PL Dental SC

  • Dental Clinic/Center
  • Saint Paul, MN
  • NPI 1972471944
  NPD (past) Authorized official

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

{
    "created_epoch": "1462838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762905600000",
    "number": "1790131761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9920 FOLEY BLVD NW STE 110",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335216",
            "telephone_number": "763-317-1166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9920 FOLEY BLVD NW STE 110",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335216",
            "telephone_number": "763-377-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LY",
        "first_name": "PHONG",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-10",
        "last_updated": "2025-11-12",
        "certification_date": "2025-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D13699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kate M Lundberg
• Mary Kay Lundt
• Alexis Ann Lusthoff, MS, BCBA, LBA
• Miranda K Lutterman, PMHNP-BC
• Luxisuites LLC
• John A Lynch, MD
• Joseph P Lynch, MD
• Sarah Joy Lynch, MS, BCBA
• Jay Martin Macgregor, MD
• Jessica Dawn Mack, MSW, LGSW

• Dentist in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2025; 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.