Healthcare Provider Details

I. General information

NPI: 1366465478
Provider Name (Legal Business Name): DAVID LYMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E G AVE
GRUNDY CENTER IA
50638-2000
US

IV. Provider business mailing address

106 E G AVE
GRUNDY CENTER IA
50638-2000
US

V. Phone/Fax

Practice location:
  • Phone: 319-824-6948
  • Fax:
Mailing address:
  • Phone: 319-824-6948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7578
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: