Healthcare Provider Details

I. General information

NPI: 1508372129
Provider Name (Legal Business Name): LYTLE DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19450 MCDONALD ST STE 101
LYTLE TX
78052-3649
US

IV. Provider business mailing address

3838 N SAM HOUSTON PKWY E STE 430
HOUSTON TX
77032-3418
US

V. Phone/Fax

Practice location:
  • Phone: 281-328-4900
  • Fax:
Mailing address:
  • Phone: 832-369-6941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25968
License Number StateTX

VIII. Authorized Official

Name: DR. GEETIKA RASTOGI
Title or Position: OWNER
Credential:
Phone: 832-369-6941