MEDICARE: DR. M. ISABEL LYRA-LEEDS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	039884-1	NY

General Provider Information

NPI Number	:	1356436067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. M. ISABEL LYRA-LEEDS D.D.S.

Provider Business Mailing Address
First Line	:	630 5TH AVE
Second Line	:	SUITE 1801
City	:	NEW YORK
State	:	NY
Zip	:	10111-0100
Country	:	US
Telephone Number	:	212-541-4010
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 5TH AVE
Second Line	:	SUITE 1801
City	:	NEW YORK
State	:	NY
Zip	:	10111-0100
Country	:	US
Telephone Number	:	212-541-4010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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