Provider Demographics
NPI:1174674915
Name:LYLY FISHER DDS PLLC
Entity Type:Organization
Organization Name:LYLY FISHER DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LYLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-271-5705
Mailing Address - Street 1:406 BURNETT AVE S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2551
Mailing Address - Country:US
Mailing Address - Phone:425-271-5705
Mailing Address - Fax:425-271-0165
Practice Address - Street 1:406 BURNETT AVE S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2551
Practice Address - Country:US
Practice Address - Phone:425-271-5705
Practice Address - Fax:425-271-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA70671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty