Provider Demographics
NPI:1164984274
Name:LYLE, ASHTON BROOKE
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:BROOKE
Last Name:LYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 GRANDE HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3925
Mailing Address - Country:US
Mailing Address - Phone:919-466-0076
Mailing Address - Fax:
Practice Address - Street 1:251 GRANDE HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3925
Practice Address - Country:US
Practice Address - Phone:919-466-0076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC49383979122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist