MEDICARE: DYRAS DENTAL PLLC

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	2901019987	MI

General Provider Information

NPI Number	:	1649650326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYRAS DENTAL PLLC

Provider Business Mailing Address
First Line	:	601 S GRAND AVE
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48933-2406
Country	:	US
Telephone Number	:	517-485-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 S GRAND AVE
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48933-2406
Country	:	US
Telephone Number	:	517-485-1900
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	LAURA DYRAS
Credential	:	DDS
Telephone Number	:	517-485-1900

Provider Enumeration Date	:	06/08/2015
Last Update Date	:	09/05/2017

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