Healthcare Provider Details

I. General information

NPI: 1770780330
Provider Name (Legal Business Name): ADAM JAMES LYTLE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2119 64TH ST SW
BYRON CENTER MI
49315-9409
US

IV. Provider business mailing address

2119 64TH ST SW
BYRON CENTER MI
49315-9409
US

V. Phone/Fax

Practice location:
  • Phone: 616-217-3632
  • Fax:
Mailing address:
  • Phone: 616-217-3632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901019634
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4090
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901019634
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: