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General NPI Number Information
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NPI Number | 1932329588
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Entity Type | Organization
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Legal Business Name | JASON D LYMAN DMD PC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 407 E IOWA ST
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City | HOLBROOK
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State | AZ
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Zip | 86025-2748
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Country | US
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Telephone | 928-524-6854
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Fax |
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Provider Business Mailing Address
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Address Line | 407 E IOWA ST
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City | HOLBROOK
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State | AZ
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Zip | 86025-2748
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Country | US
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Telephone | 928-524-6854
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JASON LYMAN
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Credential | DMD
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Telephone | 928-524-6854
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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 | 5256
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License Number State | AZ
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