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BLONG ROGER LY DDS

>> Dentist >> Dental Providers

Registrant NPI Number: 1255302022

Individual Registrant:
 BLONG ROGER LY DDS
Gender: M
Not Sole Proprietor

Location and contact information for practice:
5100 OBYRNES FERRY RD  JAMESTOWN, CA 95327-9102 US
Tel: 209-984-5291  Fax: --

Contact information for business:
5100 O'BYRNES FERRY ROAD  JAMESTOWN, CA 95327 US
Tel: 209-984-5291  Fax: --

Registration Information:
NPI: 1255302022
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y122300000XDental Providers
Dentist
CA51106

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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