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General NPI Number Information
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NPI Number | 1376700260
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Entity Type | Organization
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Legal Business Name | THOMAS J LYLE DDS PC
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 2707 EASTON BLVD
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City | DES MOINES
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State | IA
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Zip | 50317-6123
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Country | US
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Telephone | 515-265-0339
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Fax | 515-265-0339
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Provider Business Mailing Address
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Address Line | 2707 EASTON BLVD
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City | DES MOINES
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State | IA
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Zip | 50317-6123
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Country | US
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Telephone | 515-265-0339
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Fax | 515-265-0339
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS JAMES LYLE
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Credential | DDS
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Telephone | 515-265-0339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 06797
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License Number State | IA
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