MEDICARE: DR. SCOT EDWARD LYALL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	14999	MA

General Provider Information

NPI Number	:	1710942214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOT EDWARD LYALL DDS

Provider Business Mailing Address
First Line	:	PO BOX 127
Second Line	:	7 GORWIN DR
City	:	HANSON
State	:	MA
Zip	:	02341-0127
Country	:	US
Telephone Number	:	781-293-2128
Fax Number	:	781-294-4948

Provider Business Practice Location Address
First Line	:	7 GORWIN DR
Second Line	:
City	:	HANSON
State	:	MA
Zip	:	02341-0127
Country	:	US
Telephone Number	:	781-293-2128
Fax Number	:	781-294-4948

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	07/08/2007

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