Provider Demographics
NPI:1003946989
Name:LYLE, THOMAS CHARLES (D,DS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CHARLES
Last Name:LYLE
Suffix:
Gender:M
Credentials:D,DS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 N HIGH ST
Mailing Address - Street 2:112
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3948
Mailing Address - Country:US
Mailing Address - Phone:614-888-3483
Mailing Address - Fax:614-888-3797
Practice Address - Street 1:5655 N HIGH ST
Practice Address - Street 2:112
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3948
Practice Address - Country:US
Practice Address - Phone:614-888-3483
Practice Address - Fax:614-888-3797
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH137051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice