Healthcare Provider Details

I. General information

NPI: 1174512628
Provider Name (Legal Business Name): GEORGE E LYMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S PATTERSON AVE SUITE 113
SANTA BARBARA CA
93111-2055
US

IV. Provider business mailing address

122 S PATTERSON AVE SUITE 113
SANTA BARBARA CA
93111-2055
US

V. Phone/Fax

Practice location:
  • Phone: 805-967-5318
  • Fax: 805-967-3778
Mailing address:
  • Phone: 805-967-5318
  • Fax: 805-967-3778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number18881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: