Healthcare Provider Details

I. General information

NPI: 1851498232
Provider Name (Legal Business Name): JOHN JAMES LYTLE M.D., D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 FOOTHILL BLVD SUITE 200
LA CANADA CA
91011-2150
US

IV. Provider business mailing address

1370 FOOTHILL BLVD SUITE 200
LA CANADA CA
91011
US

V. Phone/Fax

Practice location:
  • Phone: 818-952-8183
  • Fax: 818-952-6437
Mailing address:
  • Phone: 818-952-8183
  • Fax: 818-958-6437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number14810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: