Healthcare Provider Details

I. General information

NPI: 1588412910
Provider Name (Legal Business Name): LYRIC DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 MAIN ST STE 114
JUPITER FL
33458-5244
US

IV. Provider business mailing address

38 WINDSOR LN
PALM BEACH GARDENS FL
33418-7188
US

V. Phone/Fax

Practice location:
  • Phone: 561-512-9450
  • Fax:
Mailing address:
  • Phone: 561-512-9450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LYRIC HILDEBRANDT
Title or Position: OWNER
Credential: DMD
Phone: 561-512-9450