Healthcare Provider Details

I. General information

NPI: 1225058779
Provider Name (Legal Business Name): WILLIAM REED LYTLE D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14406 NE 20TH AVE
VANCOUVER WA
98686-1448
US

IV. Provider business mailing address

11710 NW 18TH AVE
VANCOUVER WA
98685-3726
US

V. Phone/Fax

Practice location:
  • Phone: 360-571-3139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00006170
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: