Provider Demographics
NPI:1376700260
Name:THOMAS J LYLE DDS PC
Entity Type:Organization
Organization Name:THOMAS J LYLE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-265-0339
Mailing Address - Street 1:2707 EASTON BLVD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317-6123
Mailing Address - Country:US
Mailing Address - Phone:515-265-0339
Mailing Address - Fax:515-265-0339
Practice Address - Street 1:2707 EASTON BLVD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50317-6123
Practice Address - Country:US
Practice Address - Phone:515-265-0339
Practice Address - Fax:515-265-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06797122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0195958Medicaid